Management of complex tympanojugular paragangliomas including endovascular intervention

Sanna, Mario; Shin, Seung Ho; Donato, Giuseppe; Sivalingam, Shailendra; Lauda, Lorenzo; Vitullo, Francesca; Piazza, Paolo

doi:10.1002/lary.21826

Cited by 39 publications

(34 citation statements)

References 41 publications

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“…For the staged surgeries, the IFTA-A was the primary approach and the transdural-transsigmoidtranscondylar-transclival [Shin et al, 2011b] approach was performed in 7 cases (43.75%), the modified transcochlear approach [Sanna et al, 1994] in 6 cases (37.5%), with a translabyrinthine, an extreme lateral [Sen and Sekhar, 1990], and a transotic [Fisch, 1988] approach for 1 case (6.25%) each ( table 4 b). In complex cases with vagal paragangliomas, a transcervical second-stage approach was performed for removal of the vagal component [Sanna et al, 2011;Shin et al, 2011a]. The average time interval between the initial and the second procedure was 11 months with a range of 3-21 months.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Surgical Management of Tympanojugular Paragangliomas with Intradural Extension, with a Proposed Revision of the Fisch Classification

et al. 2012

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Background: Tympanojugular paragangliomas (TJPs) with intradural extension can be successfully treated by a single or staged procedure with low surgical morbidity. Objectives: To present the clinical findings and treatment methods used for surgically treating TJP with intradural extension, as well as to discuss the complications of treatment and the relative merits of single versus staged surgery by using a comprehensive literature review comparing objective outcome measures. Study Design: A retrospective case review of 45 cases of TJP with intradural extension. Setting: A quaternary skull base and neurotologic center. Materials and Methods: The charts of 45 patients with Fisch classification class C or D TJP with intradural extension, who were operated on from April 1988 to April 2010, were analyzed. Clinical findings and preoperative lower cranial nerve (LCN) palsy as well as postoperative totality of resection, postoperative LCN palsy and complications were studied. The types, indications, and distribution of staged procedures were also analyzed. Results: Out of 45 cases, 22 were C3di2. The IX and X cranial nerves were the commonest nerves affected preoperatively. Preoperative internal carotid artery management was performed in 16 cases. Twenty-nine cases had a single procedure and 16 had a staged procedure. The main indication for staged procedures was intradural extension of 2 cm or more. The infratemporal fossa approach (ITFA) type A was the main procedure in all cases. Overall, total resection was achieved in 68.8% of cases with postoperative cerebrospinal fluid leak in 4.4% cases. Postoperative House-Beckmann grade I–III facial nerve status was maintained in 80% of cases, and overall LCN preservation rate was 56.9%. There were no cases requiring tracheostomy, and 3 cases required delayed phonosurgical procedures to improve their voice. Conclusions: TJP with intradural extension can be successfully managed with the judicious use of staged procedures to reduce the incidence of postoperative cerebrospinal fluid leak. The ITFA did not cause an excessively high rate of facial nerve palsy, and the overall total resection and LCN preservation rate compares very favorably with previously published data.

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Section: Surgical Proceduresmentioning

confidence: 99%

Surgical Management of Tympanojugular Paragangliomas with Intradural Extension, with a Proposed Revision of the Fisch Classification

et al. 2012

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“…Patients can be considered as having a high risk of intraoperative ICA injury if (1) an encasement reaches more than half (i.e. 180-360°) of the arterial circumference, (2) there is evidence of stenosis or irregularity of vessel walls, (3) they have undergone previous treatment (radiation therapy or surgery) around the ICA, and in case of (4) multiple ipsilateral lesions, (5) single ipsilateral ICA, or (6) recurrent disease medial to the petrous ICA [Al-Mefty and Teixeira, 2002;Sanna et al, 2011].…”

Section: Discussionmentioning

confidence: 99%

“…Carotid involvement requires appropriate treatment to avoid intraoperative morbidity and mortality from vascular compromise and to reduce the likelihood of residual disease [Sanna et al, 2006b[Sanna et al, , 2009. Preoperative procedures on the ICA include permanent balloon occlusion (PBO) [Andrews et al, 1989;Sanna et al, 2004], extracranial to intracranial bypass grafting [Miyazaki et al, 1990] and reinforcement with a stent [Nussbaum et al, 2000;Cohen et al, 2003;Sanna et al, 2006b;Piazza et al, 2007;Sanna et al, 2009;Konishi et al, 2011;Sanna et al, 2011;Alaraj et al, 2012;Shin et al, 2012a]. Stenting of the cervical and petrous segments of the ICA has been introduced by the Gruppo Otologico in the management of complex paragangliomas of the head, neck and skull base since 2003 as a method of avoiding preoperative closure or bypass procedures and of protecting and preserving the integrity of the artery during surgery, mainly in cases in which the collateral flow through the circle of Willis is deemed insufficient [Sanna et al, 2006a;Piazza et al, 2007;Konishi et al, 2011].…”

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confidence: 99%

“…foramen magnum and clivus; (4) significant involvement (encasement and stenosis) of the internal carotid artery (ICA); (5) single ICA on the lesion side; (6) involvement of the vertebral artery; (7) dominant or unilateral sigmoid sinus on the lesion side; (8) bilateral or multiple paragangliomas, and (9) recurrence after previous surgery [AlMefty and Teixeira, 2002;Sanna et al, 2011]. The same criteria can also be applied to VP and CBT, particularly with regard to the ICA [Shin et al, 2012b].…”

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confidence: 99%

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Preoperative Protective Stenting of the Internal Carotid Artery in the Management of Complex Head and Neck Paragangliomas: Long-Term Results

Piazza

Lella

Bacciu³

et al. 2013

Audiol Neurotol

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Objectives: To investigate the long-term results of preoperative stenting of the internal carotid artery (ICA) in complex head and neck paragangliomas (HNP) as well as to report on indications and technical details of the procedure. Method: A comprehensive retrospective review of patients affected by HNP, consecutively operated on and preoperatively treated with stenting of the ICA in a quaternary referral skull base center, was performed. Results: Nineteen patients affected by complex HNP were identified, on whom 21 preoperative stenting procedures were performed. The mean follow-up period after stent insertion was 53.8 months; the patients' age ranged from 33 to 56 years. Fourteen patients were affected by tympanojugular paragangliomas, 4 by vagal paragangliomas and 1 by bilateral carotid body tumors. Five patients presented with recurrent tumors, while 7 presented with multiple or bilateral HNP. There were no complications associated with endovascular procedures. Total tumor removal was accomplished in 52.4% of the cases with 1 recurrence. An advanced stage was the main factor conditioning total removal. Clinical control was obtained in 80% of the patients with residual disease. Total tumor removal from and around the ICA was obtained in 95.2% of the cases. Long-term stent patency was evident in 20 of 21 cases. Conclusions: Preoperative stenting of the ICA represents a safe and effective procedure in selected cases, obviating the need for balloon occlusion or bypass procedures and reducing the risk of intraoperative vascular injury.

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“…Therefore facilities for vascular repair, reconstruction, on table balloon occlusion and rapid transfer to the neuroradiology suite should be available for all CBT. ICA stenting is a good option to reduce intraoperative injury and we have utilized this technique for complex tympanojugular paragangliomas without postoperative complications [3][4][5]. We report a case of large bilateral carotid body tumors where bilateral uncomplicated surgical removal was performed in a staged fashion with the use of uncovered ICA stents.…”

Section: Introductionmentioning

confidence: 97%

The use of internal carotid artery stenting in management of bilateral carotid body tumors

Konishi

Piazza

Shin

et al. 2011

Eur Arch Otorhinolaryngol

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Management of complex tympanojugular paragangliomas including endovascular intervention

Cited by 39 publications

References 41 publications

Surgical Management of Tympanojugular Paragangliomas with Intradural Extension, with a Proposed Revision of the Fisch Classification

Surgical Management of Tympanojugular Paragangliomas with Intradural Extension, with a Proposed Revision of the Fisch Classification

Preoperative Protective Stenting of the Internal Carotid Artery in the Management of Complex Head and Neck Paragangliomas: Long-Term Results

The use of internal carotid artery stenting in management of bilateral carotid body tumors

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