Article

Carotid body tumor resection: does the need for vascular reconstruction worsen outcome?

Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Annals of Vascular Surgery (impact factor: 1.03). 08/2006; 20(4):435-9. DOI:10.1007/s10016-006-9093-0 pp.435-9
Source: PubMed

ABSTRACT We evaluated outcomes after carotid body tumor resection (CBR) requiring vascular reconstruction. Patients undergoing CBR at an academic medical center between 1990 and 2005 were identified. Medical records were retrospectively reviewed for clinical data, operative details, Shamblin's classification, tumor pathology, complications, and mortality. Comparisons were performed between those undergoing CBR alone and CBR requiring vascular reconstruction (CBR-VASC). Of the 71 CBRs performed in 62 patients, 16 required vascular reconstruction (23%). Although there was no difference in mean tumor size (CBR 29.1 +/- 11.9 mm, CBR-VASC 32.5 +/- 9.9 mm; p = 0.133), carotid body tumors were more commonly Shamblin's I when CBR was performed alone (CBR 53% vs. CBR-VASC 25%, p = 0.045) and Shamblin's II/III when vascular reconstruction was required (CBR 47% vs. CBR-VASC 75%, p = 0.045). There was also a significant difference in malignant tumor pathology when vascular reconstruction was required (CBR 4.4% vs. CBR-VASC 25%, p = 0.034). Cranial nerve dysfunction was higher in patients requiring vascular repair (CBR 27% vs. CBR-VASC 63%, p = 0.012), but there was no difference in baroreflex failure (CBR 7.27% vs. CBR-VASC 0%, p = 0.351), Horner's syndrome (CBR 5.5% vs. CBR-VASC 6.25%, p = 0.783), or first bite syndrome (CBR 7.27% vs. CBR-VASC 12.5%, p = 0.877). There were no perioperative strokes in either group, and one death was unrelated to operation. When required, carotid artery reconstruction at the time of CBR can be performed safely. Although cranial nerve dysfunction is more common when vascular repair is required, this is more likely related to locally advanced disease and tumor pathology rather than operative techniques.

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    Article: Nonresectable carotid body tumor: Hybrid surgical procedure to achieve complete and safe resection
    Luis Mauricio Hurtado-Lopez MD, Gustavo Fink-Josephi MD, ISES, FACA, Luis Ramos-Méndez MD, Ernesto Dena-Espinoza MD
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    ABSTRACT: Background Carotid body tumors of Shamblin class III without free internal carotid, between the tumor and skull base, are considered nonresectable. The objective of this work is to describe a surgical technique that combines traditional and endovascular strategies to achieve a safe surgical resection of the carotid body tumor of this class.Methods and ResultsA female patient with a nonresectable carotid body tumor underwent placement of an endoprosthesis going from the common carotid artery to the internal carotid beyond the skull base (to secure cerebral circulation) excluding the external carotid artery. Forty-five days later, the tumor was resected without vascular or cranial nerves injury, and bleeding amounted to 50 cm3. At 6 months, the patient is tumor free and asymptomatic.Conclusion This is the first known reported case that has been successfully resolved by combining endovascular and traditional strategies. The endoprosthesis maintained cerebral circulation, which otherwisewould have been impossible; besides, the vascular supply from the external carotid artery was excluded leading to a decrease in tumor size and a recovery of the subadventitial dissection plane, allowing for a successful and safe tumor resection. © 2008 Wiley Periodicals, Inc. Head Neck, 2008
    Head & Neck 11/2008; 30(12):1646 - 1649. · 2.40 Impact Factor
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    Article: Carotid body tumors: radioguided surgical approach.
    Ombretta Martinelli, Luigi Irace, Rita Massa, Sara Savelli, Fabrizia Giannoni, Roberto Gattuso, Bruno Gossetti, Fabrizio Benedetti-Valentini, Luciano Izzo
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    ABSTRACT: Carotid body tumours (CBTs) are very rare lesions which should be treated as soon as possible even when benign since small tumour size permits easier removal and lower incidence of perioperative complications and recurrence. Malignant forms are rare and they can be identified by lymph node invasion and metastases in distant locations. The need of reliable and effective diagnostic modalities for both primary CBTs and its metastases or recurrence is evident.The present study reviews our experience and attempt to define the role of colour coded ultrasound (CCU) and Somatostatin receptor scintigraphy (SRS) with Indium-111-DTPA-pentetretide (Octreoscan(R)) using both planar and single photon emission tomography (SPECT) technique in the diagnosis and follow-up of these uncommon lesions within a multidisciplinary approach. From 1997 to 2008, 12 patients suffering from 16 CBTs (4 bilateral) were investigated by CCU and SRS-SPECT before and after surgery. All tumours were grouped according to Shamblin's classification in order to assess the technical difficulties and morbidity of surgical resection on the ground of their size and relationship with the carotid arteries. Intraoperative radiocaptation by Octreoscan(R)) was also carried out in all cases to evaluate the radicality of surgery. All perioperative scans were evaluated by the same nuclear medicine physician. Preoperatively CCU showed CBTs (four were not palpable) with a sensitivity of 100%. Radioisotope imaging identified the CBTs as chemodectomas in 15 cases while no radioisotopic uptake was detected in 1 vagus nerve neurinoma. No evidence of metastasis or multicentricity were seen by total body radioisotopic scans. Combined data from CCU and SRS-SPECT allowed to determine tumour size in order to select 7 larger tumours which were submitted to selective preoperative embolization.Intraoperatively Octreoscan demonstrated microscopic tumour leftovers promptly removed in 1 case and an unresectable remnant at the base of the skull in another case.During follow-up CCI and radioisotope scans showed no recurrence in 14 cases and a slightly enlargement of the intracranial residual as detected during surgery in 1 patient. CCU may allow an early and noninvasive detection of CBTs and hence safer operations. The combined use of CCU and SRS-SPECT provide useful data to identify those tumours and to evaluate their extent and carotid arteries infiltration. Radioisotope imaging is a sensitive modality to detect metastases and lymph node involvement that are markers of CBT malignancy. After surgery CCU and SRS-SPECT can be accurate modalities for surveillance for an early detection of CBTs recurrence.
    Journal of Experimental & Clinical Cancer Research 12/2009; 28:148. · 2.15 Impact Factor
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Keywords

62 patients
 
academic medical center
 
baroreflex failure
 
carotid artery reconstruction
 
carotid body tumor resection
 
carotid body tumors
 
CBR-VASC 0%
 
clinical data
 
cranial nerve dysfunction
 
malignant tumor pathology
 
Medical records
 
operative details
 
operative techniques
 
patients
 
Patients undergoing CBR
 
perioperative strokes
 
Shamblin's classification
 
tumor pathology
 
tumor size
 
undergoing CBR