The known unknowns of perioperative stroke during carotid body tumour resection

Joshi, Meera Suresh; Lattimer, Christopher; Shah, Bareen; Geroulakos, George

doi:10.1136/bcr-2012-006416

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Furthermore, intraoperative electroencephalographic monitoring can also be helpful in lowering the risk of neurological morbidity during surgical manipulation. 7 We also highlight the importance of vascular imaging preoperatively to identify possible anatomic variants which can contribute to brain ischemia.…”

Section: Discussionmentioning

confidence: 95%

“…Risk of stroke following excision of CBT are highly variable have been reported to range between 0% to 20%. 7 Angioembolisation is an adjunct procedure done prior to surgery to devascularise CBT. 8 First described by Schick et al, preoperative embolization was done to aid in reducing blood loss and operative time.…”

Section: Discussionmentioning

confidence: 99%

“…9 Nonetheless, angioembolization has its fair share of complications mainly risk of neurological complications even in the experienced operators. 7,10 Certain authors have reported that the risk of stroke following post-embolization may even exceed 10%. 11 Although the claimed benefits remain debatable, pre-operative angioembolization techniques are still employed to reduce the risk of intraoperative bleeding which allow a bloodless surgical field to ensure safe and proper excision of the tumour.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Carotid body tumour: an enigma that remains

Lim

Saniasiaya

Rohana

et al. 2019

Int J Otorhinolaryngol Head Neck Surg

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<p class="abstract">Carotid body tumour is a form of paraganglioma which arises from the carotid body. This tumour is known for its rich vascular supply mainly contributed by the ascending pharyngeal artery, a branch from external carotid artery. Surgical excision preceded by pre-operatic embolization remains the definitive treatment despite the countless feared complications. We present our experience with a case of carotid body tumour which was embolised prior to surgical excision, unfortunately complicated with a thromboembolic event. This patient was found to have an anatomical variation in the cerebrovascular anatomy known as a fetal posterior cerebral artery which led to a paradoxical PCA infarction post-embolization. We would like to highlight this rare presentation along with its management as there were scarce evidence of this case in the literature.</p>

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Carotid body tumour: an enigma that remains

Lim

Saniasiaya

Rohana

et al. 2019

Int J Otorhinolaryngol Head Neck Surg

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Carotid Body Tumours: Benign but Challenging

Kakisis

Geroulakos

2019

European Journal of Vascular and Endovascular Surgery

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Multidisciplinary management of carotid body tumors: a single-institution case series of 22 patients

Ramos

Carnevale

Majeed

et al. 2023

Journal of Neurosurgery

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OBJECTIVE Carotid body tumors (CBTs) are rare, slow-growing neoplasms derived from the parasympathetic paraganglia of the carotid bodies. Although inherently vascular lesions, the role of preoperative embolization prior to resection remains controversial. In this report, the authors describe an institutional series of patients with CBT successfully treated via resection following preoperative embolization and compare the results in this series to previously reported outcomes in the treatment of CBT. METHODS All CBTs resected between 2013 and 2019 at a single institution were retrospectively identified. All patients had undergone preoperative embolization performed by interventional neuroradiologists, and all had been operated on by a combined team of cerebrovascular neurosurgeons and otolaryngology–head and neck surgeons. The clinical, radiographic, endovascular, and perioperative data were collected. All procedural complications were recorded. RESULTS Among 22 patients with CBT, 63.6% were female and the median age was 55.5 years at the time of surgery. The most common presenting symptoms included a palpable neck mass (59.1%) and voice changes (22.7%). The average tumor volume was 15.01 ± 14.41 cm3. Most of the CBTs were Shamblin group 2 (95.5%). Blood was predominantly supplied from branches of the ascending pharyngeal artery, with an average of 2 vascular pedicles (range 1–4). Fifty percent of the tumors were embolized with more than one material: polyvinyl alcohol, 95.5%; Onyx, 50.0%; and N-butyl cyanoacrylate glue, 9.1%. The average reduction in tumor blush following embolization was 83% (range 40%–95%). No embolization procedural complications occurred. All resections were performed within 30 hours of embolization. The average operative time was 173.9 minutes, average estimated blood loss was 151.8 ml, and median length of hospital stay was 4 days. The rate of permanent postoperative complications was 0%; 2 patients experienced transient hoarseness, and 1 patient had medical complications related to alcohol withdrawal. CONCLUSIONS This series reveals that endovascular embolization of CBT is a safe and effective technique for tumor devascularization, making preoperative angiography and embolization an important consideration in the management of CBT. Moreover, the successful management of CBT at the authors’ institution rests on a multidisciplinary approach whereby endovascular surgeons, neurosurgeons, and ear, nose, and throat–head and neck surgeons work together to optimally manage each patient with CBT.

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The known unknowns of perioperative stroke during carotid body tumour resection

Cited by 3 publications

References 11 publications

Carotid body tumour: an enigma that remains

Carotid body tumour: an enigma that remains

Carotid Body Tumours: Benign but Challenging

Multidisciplinary management of carotid body tumors: a single-institution case series of 22 patients

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