Radio-guided surgery in recurrent renal hyperparathyroidism: Report of a case

Abstract

Background It has been demonstrated that radio‐guided surgery offers several advantages in treating primary hyperparathyroidism. Even if it is considered less helpful in renal hyperparathyroidism, it could be of tremendous advantage in the treatment of persistent or recurrent secondary hyperparathyroidism. Methods We report a case of recurrent secondary hyperparathyroidism treated by the use of radio‐guided surgery. The preoperative assessment consisting of ultrasonography, magnetic resonance imaging, and 99mTc‐sestamibi scintigraphy identified a parathyroid in the upper mediastinum. The patient underwent a radio‐guided neck re‐exploration that allowed a rapid localization and excision of the ectopic gland, which was located in the anterosuperior mediastinum, in front of the trachea, between the innominant and the left common carotid artery. Results The operative time was 45 minutes. The patient was discharged on the first postoperative day. A decrease in serum calcium and parathyroid hormone was observed subsequently. A follow‐up of 6 months did not show any recurrence. Conclusions The case reported indicates that radio‐guided surgery can help surgeons detect parathyroid tissue in selected cases of renal hyperparathyroidism. © 2000 John Wiley & Sons, Inc. Head Neck 22: 618–620, 2000.

A comprehensive overview of radioguided surgery using gamma detection probe technology

“…While the role of utilizing intraoperative gamma probe detection during radioguided parathyroid surgery is well established for parathyroid adenomas, few reports have focused on its effectiveness for hyperplastic parathyroid glands demonstrated in either primary or secondary/tertiary hyperparathyroidism [ 432 - 440 ]. This approach was first successfully reported in 2000 by Rossi et al [ 432 ] in 11 patients with persistent hyperparathyroidism undergoing reoperative neck exploration for localizing residual hyperfunctioning parathyroid tissue and by Navarra et al [ 433 ] in a single patient with recurrent secondary renal hyperparathyroidism. The largest series to date has been reported by Chen et al [ 436 ], in which they compared the results of minimally-invasive radioguided parathyroid surgery in 25 patients with secondary/tertiary hyperparathyroidism with that of 77 patients with primary hyperparathyroidism.…”