Retrocarotid dissection technique compared to the caudocranial approach for the surgical treatment of carotid body tumors: A 15-year experience.

INTRODUCTION: Carotid body tumors are rare neoplasms with malignant potential. We aim to follow up on our initial experience published in 2015 and compare the occurrence of complications and postoperative outcomes with the use of retrocarotid dissection (RCD) against the standard caudocranial (SCCD) technique. METHODS: This was an observational, case-control study in which we analyzed all of the carotid body tumor resections performed from 1986 to 2022. Parametric and nonparametric tests were used accordingly. Statistical analysis was performed on Stata 17. RESULTS: A total of 181 surgical procedures were included, mean age was 56 years (± 13.63), and 168 (93%) were performed in women. The mean medio-lateral diameter was larger in the RCD group (2.85 ± 1.57 cm vs 1.93 ±1.85 cm; p = 0.002) and presurgical embolization was more frequently performed in the SCCD group (27.5% vs 0.7%; p < 0.001). A total of 40 (22.09%) resections were performed using the SCCD technique. In contrast, in 141 (77.91%) procedures the RCD technique was used. The mean surgical time in the RCD group was lower (197.37 ± 70.56 min vs 232 ± 98.34 min; p = 0.01). No statistically significant difference was found between SCCD and RCD in terms of vascular lesions (n = 20 [11.04%], 15% vs 9%, respectively; p = 0.36), transient or permanent nerve injuries (25% vs 33%, respectively; p = 0.31), or mean intraoperative bleeding (SCCD: 689.95 ± 680.05 mL vs RCD: 619.64 ± 837.94 mL; p > 0.05). CONCLUSIONS: RCD appears to be a safe and equivalent alternative to the standard caudocranial approach in terms of intraoperative bleeding or vascular lesions, with a sustained, significant decrease in surgical time.

Physiological and clinical impact in the carotid baroreceptor function following the surgical management of bilateral carotid body tumors.

OBJECTIVE: The bilateral presentation of Carotid Body Tumors (CBT) is rare; the surgical resection of these masses remains the mainstay management due to the malignant potential. We aim to describe, classify, and quantify baroreceptor failure (BRF) after the surgical management of patients with bilateral CBT to better understand the clinical consequences. METHODS: Retrospective review of patients that underwent bilateral CBT resection to assess the changes in baroreceptor function. We describe the clinical events associated to BRF after surgery, baseline patient's demographics, characteristics, comorbidities. Additionally, clinical and a quantitative evaluation of baroreceptor sensitivity were conducted using the Composite Autonomic Severity Score (CASS). RESULTS: From 1986 to 2020, a total 146 CBT resections were performed in 132 patients in our institution. Tumors were removed bilaterally in staged procedures in seven patients with a mean age of 61 years (Standard Deviation 11), six (85%) were females, and there was no family history of paragangliomas. The clinical presentation were palpable masses in 5 (71%), and odynophagia in 2 (29%) cases; malignant histopathology following surgery was found in one case. BRF occurred in one patient after unilateral CBT resection, consisting of bradycardia and a 40 s asystole that was not previously associated to BR sensitivity. Three (43%) patients presented BRF in the immediate postoperative period of the contralateral CBT excision, consisting of volatile hypertensive crisis in two cases, and supraventricular tachycardia in one. All the patients developed (100%) chronic baroreceptor sensitivity symptoms consisting in syncope, vertigo and fatigue in 4 (57%), tachycardia in 2 (28%), and orthostatic headache in one (14%). Autonomic testing showed mixed sympathetic and parasympathetic failure in five (71%), severe sympathetic failure in 1 (14%), and parasympathetic dysfunction in one patient (14%). CONCLUSIONS: Postoperative autonomic assessment confirmed BRF in all studied patients that underwent staged bilateral CBT resection with mixed, sympathetic, and parasympathetic dysfunction. Further studies are necessary to evaluate the incidence and physiological mechanisms of these sequelae to anticipate possible complications and offer the appropriate perioperative management.

Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors.

OBJECTIVE: Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach. MATERIALS AND METHODS: Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre. RESULTS: We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc. SYMPTOMS: Presence of tumors in the neck in all cases and two cases of dysphagia. CONCLUSION: This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.

Paraganglioma cuerpo carotídeo: experiencia en 20 años y revisión de la literatura / Carotid body paraganglioma: 20-year experience and literature review

Resumen El paraganglioma carotideo es un tumor infrecuente, originado de las células de la cresta neural. Raramente son secretores y tienen un bajo potencial maligno. El diagnóstico es difícil y requiere una alta sospecha clínica, combinada con estudios imagenológicos. Su tratamiento está basado en la cirugía, con especial cuidado de las estructuras vasculonerviosas que se encuentran en intimo contacto. Se describe la casuística de paragangliomas de cuerpo carotídeo en Clínica Las Condes y compararla con una revisión de la literatura actualizada del tema.

Abstract Carotid paraganglioma is a rare tumor, originated from neural crest cells. Usually they lack hormone secretion function, and have a low malignant potential. Diagnosis is difficult, and requires high clinical suspicious, combined with image and pathologic findings. Its treatment is based on surgery, with special care of close anatomic relation with important vascular-nervous structures. Here, we present cases of carotid paragangliomas evaluated at Clinica Las Condes comparing them with an updated literature review.

Giant Cell Tumor of the Carotid Body: A Rare Tumor with Malignant Potential.

Introduction: Carotid body tumors (CBTs) are certainly unusual. They are vascular lesions originating from paraganglionic cells, located at the common carotid artery (CCA) bifurcation. They represent less than 0.5% of head and neck tumors, approximately 1-3 cases per million. Malignant CBTs are extremely rare; in the literature, published rates on average are < 10%. The diagnostic criteria for malignancy should be based on the finding of distant metastasis. Due to its unpredictable nature and its malignant potential, diagnosis before metastasis and complete surgical resection are the keys to a favorable prognosis. Case Report: Given little experience in CBTs, its biology and treatment remain uncertain. We present the case of a 48-years-old patient, with a mass on the left side of the neck that was found to be a vast CBT with suspicious histopathology. Its size, rare location, pathologic findings, and management strategy applied for its treatment, illustrate an unusual case that highlights the importance of its publication. Conclusions: CBT is rare, but subject to cure lesion if resected without metastatic or residual disease. This is why surgery should be performed whenever possible and why it is so necessary to study this pathology thoroughly and to take it into account in the differential diagnosis.

Caracterización Epidemiológica de los Pacientes con Diagnóstco de Glomus Carotdeo Sometdos a Resección en la Unidad de Cirugía Cardiovascular de Guatemala / Epidemiological Characterization of patients with carotid body tumors who underwent resection in the vascular unit in Guatemala (UNICAR)

Introducción: Los tumores del cuerpo carotideo son tumores infrecuentes, generalmente benignos y muy vascularizados, por lo que su resección es un reto para el cirujano. El objetivo de este estudio es realizar una caracterización epidemiológica de los pacientes con glomus carotideo operados en la Unidad de Cirugía Cardiovascular de Guatemala (UNICAR) Metodología: El estudio fue descriptvo retrospectivo analizando los registros clínicos de todos los pacientes sometidos a resección de glomus carotideo en UNICAR de enero de 2,002 a diciembre de 2,015. Resultados: Se documentaron 17 pacientes a quienes se les realizo resección de glomus en la unidad, de los cuales 1 expediente no fue posible analizar porque no se encontró en el archivo. El 93% de los pacientes fueron de sexo femenino lo cual está descrito que es el género más afectado. La altitud es característica de esta patología ya que el 93%, 15 de los 16 venían de una altura mayor de los 1,500 mts sobre el nivel del mar. No se pudo determinar la etnia como factor de riesgo ya que el 50% de los pacientes fueron de etnia indígena y el 50% de etnia ladina. Se obtuvo un caso de herencia familiar ya que tanto la abuela como la nieta presentaron glomus carotideo. Las biopsias que se documentaron fueron solamente en 5 pero pensamos que hay un subregistro ya que consultando con los especialistas estás pudieron haber sido más. Conclusiones: El Glomus Carotideo es una patología poco frecuente, sin embargo, debe ser tratado en unidades especializadas vasculares debido a su compleja resección y el importante riesgo de sangrado. En este estudio se logró caracterizar epidemiológicamente a los pacientes, coincidiendo con lo reportado en la literatura mundial.

Background: Carotid body tumors are uncommon, generally benign, hypervascular turmors; resection is a challenge for surgeons. The aim of this study is to characterize patents with carotid body tumors who underwent resection at the Cardiovascular Surgical Unit in Guatemala (UNICAR) Methods and Results: There were a total of 17 patents in this descriptve and retrospectve trial who underwent resection of carotid body tumor during 2002 to 2015, but we only had access to 16 of the patents clinical records. 93% were female patents, this is the same as reported in other trials being women more affected than men. Altitude of more than 1,500 m from sea level was present in 93% of the patents. This is remarkable due to the country's geography where there can be in some department's altitudes from 0 m at sea level to as high as 2,800 m. Their background in race speaking isn't related to the presence of this pathology, 50% were indigenous and 50% were ladinos. There was only one case of family related heritage where grandmother and granddaughter had a carotid body tumor resection. Previous biopsy was only recorded in 5 clinical records but we think this can be a sub registry due to the experience of some of the surgeons who said most of them had previous scars and it made the resection more difficult. Conclusions: Carotid body tumors are rare in presentation and they must be treated in a specialized vascular unit due to its complex resection and hemorrhage risk.