Surgical Treatment of Carotid Body Paragangliomas: Outcomes and Complications According to the Shamblin Classification

Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Korea.
Clinical and Experimental Otorhinolaryngology (Impact Factor: 0.85). 06/2010; 3(2):91-5. DOI: 10.3342/ceo.2010.3.2.91
Source: PubMed


The objective of this study was to review our experience in the surgical management of carotid body paragangliomas and evaluate the outcomes and complications according to the Shamblin classification.
Thirteen patients who had been diagnosed and surgically treated for carotid body tumors (CBTs) were enrolled in this study. We reviewed patient demographics, radiographic findings, and surgical outcomes collected from medical records.
Fifteen CBTs were found in 13 patients and 13 tumors were resected. Selective preoperative tumor embolization was performed on six patients. The median blood loss, operation time, and hospital stay for these patients were not significantly reduced compared to those without embolization. The median tumor size was 2.3 cm in Shamblin I and II and 4 cm in Shamblin III. The median intraoperative blood loss was 280 mL and 700 mL, respectively (P<0.05). Internal carotid artery ligation with reconstruction was accomplished on three patients (23%), and they all belonged to Shamblin III (38%). One Shamblin III patient (8%) developed transient cerebral ischemia, and postoperative stroke with death occurred in another Shamblin III patient. Postoperative permanent cranial nerve deficit occurred in three patients (23%) who were all in Shamblin III (P=0.03). There were no recurrences or delayed complications at the median follow up of 29 months.
Shamblin III had a high risk of postoperative neurovascular complications. Therefore, early detection and prompt surgical resection of CBTs will decrease surgical morbidity.

24 Reads
  • Source
    • "The difficulty of excision can be assessed only intraoperatively. Attempts to establish preoperative relationship between tumour dimensions and surgical difficulty have been done: carotid paragangliomas over 4–5 cm surround partially or completely carotid vessels and produce higher incidence of complications [ 14 ] . "
    [Show abstract] [Hide abstract]
    ABSTRACT: Between 1972 and 2012, 25 patients presenting 32 paragangliomas of the neck were observed. Tumor locations included the carotid body (CBTs) in 21 patients and the vagus nerve in 4. Four patients had bilateral CBT and one a bilateral vagal tumor; a metachronous bilateral jugulare paraganglioma was diagnosed in one patient with bilateral CBT Shamblin type III. Five patients presented CBTs type II and three type III. Preoperative embolization was performed in 5 CBTs, with no significant difference in blood loss. Twenty-nine paragangliomas were resected (with three internal carotid artery resection): there were no cerebrovascular accident or perioperative death. Nine patients (36%) had cranial nerve palsy prior to surgery and a postoperative nerve dysfunction occurred in four other tumors (16%). Persistent nerve deficits occurred in 3 patients (12%). No evidence of malignancy was shown, intraoperatively or during a postoperative follow-up period (9 months to 18 years; mean: 8 years).
    11/2013; 6:11-5.
    • "In 1971, Shamblin et al., introduced a classification system based on the size of the tumor into groups I, II, and III.[5] Group III, like the present case, consists of tumors that are large and typically encase the CA requiring vessel resection and replacement. Most of the previous studies reported high rate of neurovascular complication (23-47%)[267] with Shamblin III tumors. The risk seems to be more significant when the tumor size is more than 5 cm[8] (similar to the present case). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Carotid body tumor is a paraganglioma derived from the neural crest. It arises from the carotid body which acts as a vascular chemoreceptors and is usually located at the carotid bifurcation. Sizeable (Shamblin III, >5 cm size) tumors are large and typically encase the carotid artery requiring vessel resection and replacement. Management of such tumors carries a high risk of postoperative mortality and morbidity rates specially with regards to neurovascular complications. We report a case of sizeable tumor which was surgically removed with minimal complications.
    04/2013; 3(4):106-108. DOI:10.4103/2231-0770.120503
  • Source
    • "Although the present case describes spontaneous involution, surgical resection is the favored treatment in carotid body tumors. Nevertheless, resection is associated with complications such as cranial nerve impairment, stroke, or partial scarification of the carotid arteries [24]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Head and neck paragangliomas are tumors associated with the parasympathetic nerve system and typically show an indolent growth pattern. Therefore a conservative management strategy is considered in selected cases. Methods and results We present a case of a female patient who presented in 2003 with bilateral carotid body tumors and a tympanic tumor, associated with a mutation in the succinate dehydrogenase -sub-unit-D (SDHD). She was operated on the right carotid body tumor and the tympanic tumor. Thereafter the follow-up was performed with MR examinations at 2-year intervals. After an initial stable phase, over the last 3 years a spontaneous near-total regression of the contralateral carotid body tumor was observed, with only subtle rest-abnormalities visible in 2011. Conclusions The present case underlines the indolent growth pattern of head and neck paragangliomas and for the first time describes a rare manifestation of spontaneous regression of a carotid body tumor. The literature was reviewed to discuss this phenomenon.
    World Journal of Surgical Oncology 10/2012; 10(1):218. DOI:10.1186/1477-7819-10-218 · 1.41 Impact Factor
Show more

Similar Publications

Preview (2 Sources)

24 Reads
Available from