Article

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

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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    • "In the literature, the best treatment is considered to be surgical , with dissection of the tumor in the sub-adventitial avascular plane of the artery (Anand et al., 1995). The first successful carotidbody tumor excision was performed by Albert in 1889 (cited afterLim et al., 2010). Gordon-Taylor (1940) described in details a safe, subadventitial dissection. "
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    • "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 ] . "
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    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).
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    • "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). "
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    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.
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