A Multidisciplinary Approach to Carotid Paragangliomas

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 p...

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Bibliographic Details
Published in:	Vascular and endovascular surgery Vol. 40; no. 6; pp. 467 - 474
Main Authors:	Kasper, Gregory C., Welling, Richard E., Wladis, Alan R., Cajacob, Daniel E., Grisham, Andre D., Tomsick, Thomas A., Gluckman, Jack L., Muck, Patrick E.
Format:	Journal Article
Language:	English
Published:	Thousand Oaks, CA SAGE Publications 01-12-2007 Westminster
Subjects:	Adult Aged Aged, 80 and over Biological and medical sciences Carotid Arteries - surgery Carotid Body Tumor - diagnosis Carotid Body Tumor - surgery Carotid Body Tumor - therapy Combined Modality Therapy Cranial Nerve Injuries - etiology Embolization, Therapeutic Female Follow-Up Studies Humans Male Medical sciences Middle Aged Neurology Neuroradiography Neurosurgery Ohio Otorhinolaryngologic Surgical Procedures - adverse effects Patient Care Team Preoperative Care Skull, brain, vascular surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Treatment Outcome Vascular diseases and vascular malformations of the nervous system Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Vascular Surgical Procedures - adverse effects Ohio carotid paraganglioma Nervous system diseases Carotid Surgery Diseases of the autonomic nervous system Paraganglioma Tumor Cardiovascular disease
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1538-5744 1938-9116
DOI:	10.1177/1538574406290254