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Complications of extracranial carotid aneurysm repair and resection of carotid body tumor
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Sachinder Singh Hans, Mary Lee
Carotid body tumor (cervical paraganglioma) are the most common head and neck paragangliomas.3,4 These tumors arise from the paraganglia cells that migrate from the neural crest near the sympathetic ganglia.3,4 These tumors may go undetected as they are benign and indolent. Large tumors, especially if they are larger than 3 cm in size, are palpable on physical examination as a neck mass anterior to sternomastoid and overlying the carotid bifurcation.3,4 The carotid body tumors are mobile in a medial-to-lateral plane. A recent review of carotid body tumors revealed a mean age of 55 years (18–94 years) at time of diagnosis with male-to-female ratio of 1:1.9.3,4 Most tumors were on the right side (57%) with 25% on the left and 17% bilateral. These tumors are usually sporadic but are familial in 10–20% of patients.3,4 These tumors can have malignant potential (4.3%); spread to the local (cervical) lymph nodes is the most common, and spread to liver, lung, and bone occurs in less than 5% of cases.3,4 Preoperative embolization should typically be reserved, tumors greater than 5 cm in transverse diameter.3,4 When embolization is performed, surgical resection is recommended within 24–48 hours to avoid post embolization inflammation.3,4 If the need for exposure for distal ICA for tumors extending toward the base of the skull by preoperative imaging, nasotracheal intubation, and/or mandibular subluxation should be considered.5 In our institution, both ENT and oral-maxillofacial surgeons perform this procedure.5 Due to forward displacement of the mandible, a narrow triangular field becomes a rectangular field, increasing the width of distal exposure. There is associated local distortion of the local anatomy with displacement of posterior belly of digastric and hypoglossal nerve anteriorly and superiorly, and the carotid bifurcation and right ICA are rotated medially following mandibular subluxation.5 Intraoperative cerebral monitoring with electroencephalography and median nerve evoked potentials should be considered in patients undergoing resection of large carotid body tumors. As a first step, the common carotid artery is exposed at the base of the neck with early identification of the vagus nerve. The dissection plane is carried out in subadventitial base with the aid of bipolar cautery. This avascular space was first described by Gordon-Taylor as the “white line.” Distal exposure can be facilitated with division of the posterior belly of digastric muscle and stylohyoid, avoiding injury to the glossopharyngeal nerve. Ligation and division of the occipital artery facilitates high exposure. If further exposure is required, division of stylohyoid process by the Rongeur and tip of the mastoid process may become necessary, but this can increase risk of glossopharyngeal nerve injury.
Metastatic brain carotid body paraganglioma with endocrine activity: a case report and literature review
Published in British Journal of Neurosurgery, 2019
Xiang Wang, Xianglan Zhu, Jinxiu Chen, Yanhui Liu, Qing Mao
Paraganglioma is a chromaffin-cell tumor located at extra-adrenal sites along the sympathetic and/or the parasympathetic chain. Carotid body tumor, which is one of the parasympathetic paragangliomas, also named chemodectomas, originates from similar cells that have parasympathetic innervations and chemoreceptor function. Most of the paragangliomas are benign; however, malignant tumors with aggressive behavior and distant metastasis can also occur. The most common metastatic sites for paraganglioma are local lymph nodes, bone, liver, and lung.1 A review of the literature showed that there were only six reports on paraganglioma with intracranial metastases. Two of these cases were calvarial metastasis, and the other four cases were accompanied with multiple intracerebral metastasis.1–3 The tumor may originate from any location where parasympathetic ganglia can be found. Moreover, adrenal and retroperitoneal paragangliomas have a high incidence for distant metastasis as reported in the literature.2 However, the carotid body as a primary tumor site for an intracranial metastasis has not yet been reported. In this case, the patient had undergone left carotid body tumor resection 2 years ago, and at that time, the tumor was located in the left parietal lobe, which is a common location of intracerebral metastases. To the best of our knowledge, the present case is the first report of intracerebral metastases from carotid body paraganglioma.
Major vessel invasion by thyroid cancer: a comprehensive review
Published in Expert Review of Anticancer Therapy, 2019
Michael S. Xu, Jennifer Li, Sam M. Wiseman
Arterial invasion by thyroid cancer is less commonly reported than venous invasion. The pattern of arterial involvement by thyroid cancer tends to be extraluminal encasement/abutment of the local arterial system, as opposed to the development of an intraluminal tumor thrombus. The most commonly affected arteries are the CAs [25,49,70,71], although there have also been isolated reports of aortic arch [71] and subclavian artery [70] invasion. Several, reported cases of arterial invasion by thyroid cancer are notable. Nomori et al. [49] reported on a case of locally advanced PTC that presented with concurrent invasion of the trachea and brachiocephalic artery, both of which were surgically resected. The brachiocephalic artery was reconstructed using a synthetic graft, while the tracheal resection defect was reconstructed with an end-to-end tracheal anastomosis. Korkmaz et al. [72] reported on a case of PTC with invasion into the left carotid bifurcation that masqueraded as a carotid body tumor. Bhargav et al. [71] reported a single case of stage IVB ATC with extensive CA and tracheal encasement that extended to the level of the aortic arch, and was resected. However, the patient’s postoperative outcome was not reported. A case series reported by Brown and Ducic described four ATC patients with encasement of the CA by thyroid cancer. The four patients were palliated non-surgically, and had an average survival of 3.8 months [73].
The carotid body and associated tumors: updated review with clinical/surgical significance
Published in British Journal of Neurosurgery, 2019
Nasir Butt, Woong Kee Baek, Stefan Lachkar, Joe Iwanaga, Asma Mian, Christa Blaak, Sameer Shah, Christoph Griessenauer, R. Shane Tubbs, Marios Loukas
Paragangliomas are neuroendocrine neoplasms of the paraganglion system (Figure 2). Carotid body tumors (CBTs), though rare, constitute over 65% of the paragangliomas of the head and neck.12 Von Luschka was the first to describe a carotid body tumor in 1862. In 1880, Reigner was the first to excise a carotid body tumor, which resulted in the patient’s death.13 Scudder reported the first successful removal of a carotid body tumor in the United States in 1903.4,14