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: 0.84). 06/2010; 3(2):91-5. DOI: 10.3342/ceo.2010.3.2.91
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: Accurate views of the head and neck vessels, tumor angiogenesis and the relationship of tumor and the surrounding blood vessels are especially crucial to carotid body tumor (CBT) patients. The aim of this study was to explore the value of dual-source CT (DSCT) cerebral and carotid angiography in CBT diagnosis. DSCT cerebral and carotid angiography was performed on nine patients with CBT. Two-dimensional and three-dimensional reconstruction images were obtained by means of multiple planar reconstructions (MPR), maximum intensity projection (MIP) and volume rendering (VR). All patients were subjected to color Doppler flow imaging (CDFI) examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery. DSCT angiography was successful in all patients. CBTs were diagnosed in 9 patients with 10 lesions (1 case had multiple bilateral CBTs). The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients had clearly demonstrated head and neck vessels, tumor angiogenesis, and tumor relationship with the surrounding blood vessels. The internal and external carotid artery (ICA, ECA) were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases (4 tumors) showed arterial phase homogeneous enhancement; 5 cases (6 tumors) had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the nearby blood vessels and tumor structure, instead of tumor angiogenesis. However, DSCT can display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings. DSCT cerebral and carotid angiography can provide reliable information for the operation. It might be a valuable CBT diagnostic method by showing accurate views of the CBT along with the bilateral neck and brain blood vessels.
    Chinese medical journal 10/2010; 123(20):2816-9. · 1.02 Impact Factor
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    Canadian Medical Association Journal 06/2011; 183(9):E606. DOI:10.1503/cmaj.092114 · 5.81 Impact Factor
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    ABSTRACT: Background Carotid body tumors (CBTs) represent a challenging problem in both diagnosis and curative treatment. MSCT angiography and MRI are established methods for CBTs diagnosis.Aim of the studyRetrospective MSCTA and MR imaging analysis were reviewed in order to get objective geometric criteria compared to operative shambling classification.Materials and methods15 CBTs cases in 14 patients (one patient had bilateral tumors) were included in this study; surgical resection was done successfully in all and surgical data analysis including Shamblin classification were revised. Their preoperative MSCT angiography and/or MR images were re-studied using geometric objective criteria including the angle of circumferential encasement (ACE) of the internal carotid artery (ICA) by the tumor, the angle of splaying (AS) of carotid bifurcation, maximum diameter in craniocaudal direction (MD), and the free distal segment (DS) of extracranial ICA above the tumor. Radiological and Surgical data analysis were compared and the results were obtained.ResultsRetrospective radiological geometric imaging analysis showed tumors tendency to have ACE less than 180° in Shamblin I, and between 180° and 270° in type II and more than 270° in type III. In a similar way, AS was less than 60° in most of type I tumors, 60° to less than 90° in type II and equal or more than 90° in type III tumors. Tumor size had limited impact on Shamblin classification and DS had its impact on decision of surgical resection and ICA revascularization, surgical data analysis revealed four cases of type I, six cases of type II and four cases of type III.Conclusions Geometric objective criteria obtained by MSCT angiography and/or MRI are very important in preoperative planning of CBTs surgery. The degree of circumferential encasement of ICA, the angle of splaying of the carotid bifurcation are appreciable criteria predicting Shamblin type of CBTs. These objective geometric criteria had a critical impact on the surgical outcome and vascular morbidity.
    12/2011; 42(s 3–4):373–380. DOI:10.1016/j.ejrnm.2011.09.004

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