Document Detail


A multidisciplinary approach to carotid paragangliomas.
MedLine Citation:
PMID:  17202093     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The surgical management of carotid paragangliomas can be problematic. A multidisciplinary approach was used to include vascular surgery, otolaryngology, and neuroradiology to treat these patients over 9 years. From January 1992 to July 2001, a multidisciplinary team evaluated patients with carotid paragangliomas. Analyzed patient data included age, gender, diagnostic evaluation, tumor size, preoperative tumor embolization, operative exposure, need for extracranial arterial sacrifice/reconstruction, postoperative morbidity including cranial nerve dysfunction, and long-term follow-up. Twenty-five carotid paragangliomas in 20 patients underwent multidisciplinary evaluation and management. Average age was 51 years (range, 28-83 years), and 52% were male. Diagnostic evaluation included computed tomography in 76%, magnetic resonance imaging/magnetic resonance angiography in 52%, catheter angiography in 60%, and duplex ultrasonography in 16%. An extended neck exposure was required in 11 cases (44%), mandibulotomy was used once (4%), and mandibular subluxation was never required. The external carotid artery (ECA) was sacrificed in 8 cases (32%). The carotid bifurcation was resected in 1 patient (4%) requiring interposition reconstruction of the internal carotid artery. Preoperative tumor embolization was performed for 13 tumors (52%). Operative blood loss for patients undergoing preoperative embolization (Group I) was comparable to the nonembolized group (group II): group I lost 365 +/-180 mL versus 360 +/- 101 mL for group II (P = .48). This occurred despite larger tumors (group I - 4.2 cm versus group II - 2.1 cm, P = .03) and a higher mean Shamblin class (group I - 2.5 versus group II - 1.45, P = .001) for group I. There were no perioperative mortalities. Transient cranial nerve dysfunction occurred in 13 CBTs (52%), 2 (8%) of which remained present after 4 months. Patients with carotid paragangliomas benefit from a multidisciplinary team approach. Neuroradiology has been used for selective preoperative embolization, which has decreased estimated blood loss during excision of larger complex tumors. A combined surgical team of otolaryngology and vascular surgery provides for exposure of the distal internal carotid artery as high as the skull base, limited permanent cranial nerve dysfunction, and selective early division and excision of the external carotid artery for complete tumor resection.
Authors:
Gregory C Kasper; Richard E Welling; Alan R Wladis; Daniel E CaJacob; Andre D Grisham; Thomas A Tomsick; Jack L Gluckman; Patrick E Muck
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Vascular and endovascular surgery     Volume:  40     ISSN:  1538-5744     ISO Abbreviation:  Vasc Endovascular Surg     Publication Date:    2006 Dec-2007 Jan
Date Detail:
Created Date:  2007-01-04     Completed Date:  2007-03-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136421     Medline TA:  Vasc Endovascular Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  467-74     Citation Subset:  IM    
Affiliation:
Sections of Vascular, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Carotid Arteries / surgery
Carotid Body Tumor / diagnosis,  surgery*,  therapy*
Combined Modality Therapy
Cranial Nerve Injuries / etiology
Embolization, Therapeutic*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neuroradiography
Ohio
Otorhinolaryngologic Surgical Procedures* / adverse effects
Patient Care Team
Preoperative Care
Time Factors
Treatment Outcome
Vascular Surgical Procedures* / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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