Same-Day Preventive Embolization and Surgical Excision of Carotid Body Tumor

Tamura, Akio; Nakasato, Tatsuhiko; Izumisawa, Mitsuru; Nakayama, Manabu; Ishida, Kazuyuki; Shiga, Kiyoto; Ehara, Shigeru

doi:10.1007/s00270-018-1894-3

Cited by 14 publications

(13 citation statements)

References 6 publications

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“…For patients undergoing surgery, the need for preoperative embolization remains controversial, with some authors advocating that it reduces the amount of blood loss and the sacrifice of vascular structures, while others defend that it is not recommended for CBT because of the inability to adequately embolize the tumor‐feeding vessels, since they mainly arise from the adventitia surrounding the common, external and internal carotid arteries 10,12,34 . In our study, pretreatment embolization was performed in only 12.7% of patients, being more common in the non‐CBT group (30%).…”

Section: Discussionmentioning

confidence: 70%

Head and neck paragangliomas: 30‐year experience

2020

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Background We aimed to review our experience and the changing trends in the management of head and neck paragangliomas (HNPG) over the last three decades. Methods We retrospectively reviewed 103 patients with HNPG treated at our center (1986‐2017). We included patients treated with surgery, radiotherapy, and patients maintained under active surveillance. Results Of the surgically treated patients (n = 79), 20% (12/59) of the carotid body tumors (CBT) had a cranial nerve deficit as sequela compared to 95% (19/20) of the non‐CBT. Radiotherapy controlled growth in all tumors treated with this modality (n = 10). Of the initially observed patients, 70% (14/20) remained stable and did not require additional treatment. Stratifying by decades, there was a progressive increase in patients initially attempted to be observed and a decrease in upfront surgery. No deaths attributable to the HNPG were encountered. Conclusions Surgery is an effective treatment for CBT. Nonsurgical treatment should be considered for non‐CBT.

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Section: Discussionmentioning

confidence: 70%

Head and neck paragangliomas: 30‐year experience

2020

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“…The aim of this study was to evaluate the efficacy of the preoperative embolization of feeding arteries of CBTs by analyzing the blood loss and operating time of the CBT surgery following same‐day preoperative embolization. We previously reported the efficacy of our preoperative embolization procedure as a letter . We described here the efficacy of our procedure more precisely and remarkably by increased number of the patients for the surgeons to help perform the resection of CBT safely and effectively.…”

Section: Introductionmentioning

confidence: 85%

Effective, same‐day preoperative embolization and surgical resection of carotid body tumors

et al. 2019

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Background The aim of this study was to evaluate the efficacy of the procedure by analyzing the blood loss and duration of carotid body tumor (CBT) surgery following same‐day preoperative embolization. Methods We reviewed the medical records of subjects retrospectively. Fifteen patients with 16 CBTs were enrolled in this study. Our same‐day procedure comprises preoperative embolization of the feeding arteries in the morning followed by surgery within 3 hours after the embolization is completed. Results The mean operative time and the mean amount of blood loss were 138 minutes and 29.3 mL, respectively. The tumor volume after embolization was markedly reduced and the mean reduction rate was 50%. We found that 13 CBTs had more than three feeding arteries. Almost all the postoperative complications, mainly cranial nerve paralyzes, resolved within months after surgery. Conclusion Our same‐day procedure is a safer and superior alternative to traditional CBT surgery, having good outcomes.

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“…The development of angiographic techniques and imaging revealed that the multi-angle view of the results of angiography make finding multiple feeders of CBTs easier, especially by digital subtraction angiography and construction of the three-dimensional view of the image (32, 33) (Figure 2A). Multiple feeding arteries of a CBT can be recognized using these angiographic imaging techniques, and there have been surprising results obtained by these techniques (34)(35)(36) such as that shown in Figure 2. Most CBTs have multiple feeding arteries arising from the branches of the external carotid artery (ECA), such as the superior thyroid, ascending pharyngeal, facial, and occipital arteries.…”

Section: Resultsmentioning

confidence: 99%

Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

et al. 2022

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Background: Carotid body tumor is a hypervascular tumor with multiple feeding arteries and unique orientation at the carotid bifurcation. Although resection is a radical therapy for this tumor, complete resection is challenging. Materials and Methods: Articles reporting carotid body tumor treatment and surgical resection were reviewed including case-control series and review articles. Results: Selected reports were reviewed and discussed focusing on choice of treatment, surgical difficulties and preoperative embolization of feeding arteries. Conclusion: Multiple feeding arteries and adhesion of the tumor to the carotid arterial wall are causes of difficulties in carotid body tumor resection. The effectiveness of preoperative embolization remains controversial due to the varied situations in performing surgical resection among the institutions. However, perfect embolization and resection immediately after embolization reduce blood loss and operative time of surgery for carotid body tumor.Carotid body tumor (CBT) is a rare disease that originates from the paraganglion cells (paraganglioma) of the carotid body at the carotid bifurcation. The World Health Organization classification designated this tumor as malignant because it has a malignant potency and there is no requirement to distinguish benign from malignant features in the pathological findings of specimens (1).It is well-known that malignant tumors cannot always be identified by their morphological features in histopathological examinations; clinical findings such as metastatic activity can distinguish malignant tumors from their benign counterparts. Only clinical findings, such as lung, liver, or bone metastasis, indicate that a tumor is malignant. The slow-growing feature of CBT represents an almost benign character and embryonic origin plus germline mutation of this tumor. Its potential for metastatic activity highlights the need for surgical resection. Surgical resection of CBT by head and neck surgeons must be considered once a patient is referred to a hospital. However, in contrast to the slow-growing feature of this tumor, characteristic features, such as a rich vascular network of its capsule supplied by many feeding arteries, complicate resection (2).In recent years, it has been revealed by molecular biological studies that various types of gene alterations exist in the succinate dehydrogenase (SDH) gene family such as point mutations (3-5). Most patients with CBT were shown to have variants with germline mutations, such as SDHB and SDHD. Conversely, the idea of "hereditary paragangliomapheochromocytoma syndrome" has been frequently used to explain patients with familial paraganglioma, and it extends to patients with CBT who have a family history of the disease and gene alterations (6-8). Therefore, analyses of gene alterations are needed for patients with CBT. In addition, systemic diagnosis is needed to identify other types of paraganglioma, such as pheochromocytoma, since patients with SDH variants tend to have multiple paragangliomas (9).The Sha...

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Same-Day Preventive Embolization and Surgical Excision of Carotid Body Tumor

Cited by 14 publications

References 6 publications

Head and neck paragangliomas: 30‐year experience

Head and neck paragangliomas: 30‐year experience

Effective, same‐day preoperative embolization and surgical resection of carotid body tumors

Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

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