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Diagnostic and Therapeutic Approaches to Carotid Body Tumors: Review of 24 Patients

Diagnostic and Therapeutic Approaches to Carotid Body Tumors: Review of 24 Patients Abstract Objective: To determine the clinical characteristics of carotid body tumors to define better a standardized proceeding in the management of carotid body tumors. Design: Retrospective survey. Duration of postoperative follow-up was 4 months to 16 years (median, 57 months). Setting: Institutional, tertiary care medical center. Patients: Consecutive sample of 24 patients (10 men and 14 women) with 28 carotid body tumors treated in the University of Vienna (Austria) General Hospital in 35 years. Interventions: Surgical resection, preoperative embolization. Main Outcome Measures: Initial signs, duration of symptoms, extension of the tumors, methods of investigations, and treatment modality, with special respect to the operative technique. Results: Doppler color flow imaging and angiography provided essential mainstays for definite diagnosis. Computed tomography and magnetic resonance imaging contributed additional information about tumor extension. Nineteen patients (79%) underwent surgical resection of 22 tumors, 8 (42%) after preoperative embolization. There were no perioperative deaths. Hemiplegia occurred in 1 patient, and cranial nerve palsy occurred in 5 patients. Tumor recurrence was observed in 3 patients. Five patients refused surgery or tumors were unresectable. Conclusions: Our standard diagnostic procedure consists of establishing diagnosis by Doppler color flow sonography, angiography for detailing the vascularization of the tumor, and selective embolization to enable safer surgery with less bleeding. Early surgery is recommended to minimize major risks.Arch Surg. 1997;132:279-284 References 1. Williams PL, Warwick R, eds. Gray's Anatomy . 36th ed. New York, NY: Churchill Livingstone Inc; 1980:1462-1464. 2. Khan Q, Heath D, Smith P. Anatomical variations in human carotid bodies . J Clin Pathol . 1988;41:1196-1199.Crossref 3. Heath D. The human carotid body in health and disease . J Pathol . 1991;164: 1-8.Crossref 4. Glenner GG, Grimley PM. Tumors of the extra-adrenal paraganglion system (including chemoreceptors) . In: Atlas of Tumor Pathology . Washington, DC: Armed Forces Institute of Pathology; 1974;2( (pt 9) ):13-16. 5. Dunn GD, Brown MJ, Sapsford RN, et al. Functioning middle mediastinal paraganglioma (phaeochromocytoma) associated with intercarotid paragangliomas . Lancet . 1986;1:1061-1063.Crossref 6. Bernard RP. Carotid body tumors . Am J Surg . 1992;163:494-496.Crossref 7. Kliewer KE, Wen D, Cancilla PA, Cochran AJ. Paragangliomas: assessment of prognosis by histologic, immunohistochemical, and ultrastructural techniques . Hum Pathol . 1989;20:29-39.Crossref 8. Barnes L, Taylor SR. Carotid body paragangliomas: a clinicopathologic and DNA analysis of 13 tumors . Arch Otolaryngol Head Neck Surg . 1990;116:447-453.Crossref 9. Dickinson PH, Griffin SM, Guy AJ, McNeill IF. Carotid body tumour: 30 years experience . Br J Surg . 1986;73:14-16.Crossref 10. Staats EFN, Brown RL, Smith RR. Carotid body tumors, benign and malignant . Laryngoscope . 1966;76:907-916.Crossref 11. Gordon-Taylor G. On carotid tumours . Br J Surg . 1940;28:163-172.Crossref 12. Morfit HM, Swan H, Taylor ER. Carotid body tumors, report of 12 cases, including one case with proved visceral dissemination . Arch Surg . 1953;67:194-214.Crossref 13. Monro RS. The natural history of carotid body tumours and their diagnosis and treatment with a report of five cases . Br J Surg . 1950;37:445-453.Crossref 14. Martin HE. Surgery of Head and Neck Tumors . New York, NY: Paul B Hoeber Inc; 1957:20-80. 15. Williams MD, Phillips MJ, Nelson WR, Rainer WG. Carotid body tumor . Arch Surg . 1992;127:963-968.Crossref 16. McPherson GAD, Halliday AW, Mansfield AO. Carotid body tumours and other cervical paragangliomas: diagnosis and management in 25 patients . Br J Surg . 1989;76:33-36.Crossref 17. Meyer FB, Sundt TM, Pearson BW. Carotid body tumors: a subject review and suggested surgical approach . J Neurosurg . 1986;64:377-385.Crossref 18. Wilson H. Carotid body tumors . Surgery . 1966:59:483-493. 19. Shamblin WR, ReMine WH, Sheps SG, Harrison EG. Carotid body tumor (chemodectoma): clinicopathologic analysis of ninety cases . Am Surg . 1971;122: 732-739.Crossref 20. Derchi LE, Serafini G, Rabbia C, et al. Carotid body tumors: US evaluation . Radiology . 1992;182:457-459.Crossref 21. Delcker A, Diener HC, Müller RD, Haase R. Carotid body tumor: appearance on color-flow Doppler sonography . Vasa . 1991;20:280-282. 22. Gritzmann N, Herold C, Haller J, Karnel F, Schwaighofer B. Duplex sonography of tumors of the carotid body . Cardiovasc Intervent Radiol . 1987;10:280-284.Crossref 23. Worsey MJ, Laborde AL, Bower T, et al. An evaluation of color duplex scanning in the primary diagnosis and management of carotid body tumors . Ann Vasc Surg . 1992;6:90-94.Crossref 24. Steinke W, Hennerici M, Aulich A. Doppler color flow imaging of carotid body tumors . Stroke . 1989;20:1574-1577.Crossref 25. LaMuraglia GM, Fabian RL, Brewster DC, et al. The current surgical management of carotid body paragangliomas . J Vasc Surg . 1992;15:1038-1045.Crossref 26. Bishop GB, Urist MM, Gammal TE, Peters GE, Maddox WA. Paragangliomas of the neck . Arch Surg . 1992;127:1441-1445.Crossref 27. Iacconi P, Spinelli C, Cechini M, Ricci E, Berti P, Miccoli P. Carotid body tumours: a review of eight cases . Eur J Surg Oncol . 1992;18:93-97. 28. Rabl H, Friehs I, Gutschi S, Pascher O, Koch G. Diagnosis and treatment of carotid body tumors . Thorac Cardiovasc Surg . 1993;41:340-343.Crossref 29. Sanghvi VD, Chandawarkar RY. Carotid body tumors . J Surg Oncol . 1993;54: 190-192.Crossref 30. Laube HR, Fahrenkamp AG, Böcker W, Scheld HH. Glomustumoren: eine diagnostische und chirurgische Herausforderung? Z Kardiol . 1994;83:373-380. 31. Anand VK, Alemar GO, Sanders TS. Management of the internal carotid artery during carotid body surgery . Laryngoscope . 1995;105:231-235.Crossref 32. Matticari S, Credi G, Pratesi C, Bertini D. Diagnosis and surgical treatment of the carotid body tumors . J Cardiovasc Surg . 1995;36:233-239. 33. Olsen WC, Dillon WP, Kelly WM, Norman D, Brant-Zawadzki M, Newton TH. MR imaging of paragangliomas . AJR Am J Roentgenol . 1987;148:201-204.Crossref 34. Van Gils APG, van der Mey AGL, Hoogma RPLM, et al. MRI screening of kindred at risk of developing paragangliomas: support for genomic imprinting in hereditary glomus tumours . Br J Cancer . 1992;65:903-907.Crossref 35. Dent TL, Thompson NW, Fry WJ. Carotid body tumors . Surgery . 1976;80:365-372. 36. Van Gils APG, van der Mey AGOL, Hoogma RPLM, et al. I-123 metaiodobenzylguanidine scintigraphy in patients with chemodectomas of the head and neck region . J Nucl Med . 1990;31:1147-1155. 37. Ward PH, Liu C, Vinuela F, Bentson JR. Embolization: an adjunctive measure for removal of carotid body tumors . Laryngoscope . 1988;98:1287-1291.Crossref 38. Hallet JW Jr, Nora JD, Hollier LH, Cherry KJ, Pairolero PC. Trends in neuro-vascular complications of surgical management for carotid body and cervical paraganglioma: a 50-year experience with 153 tumors . J Vasc Surg . 1988;7: 284-291.Crossref 39. Daudi FA, Thurston OG. Carotid body tumours: the University of Alberta Hospital experience . Can J Surg . 1989;32:159-161. 40. Robison JG, Shagets FW. Beckett WC, Spies JB. A multidisciplinary approach to reducing morbidity and operative blood loss during resection of carotid body tumor . Surg Gynecol Obstet . 1989;168:166-167. 41. Kraus DH, Sterman BM, Hakaim AG, et al. Carotid body tumors . Arch Otolaryngol Neck Head Surg . 1990;116:1384-1387.Crossref 42. McCabe DP, Vaccaro PS, James AG. Treatment of carotid body tumors . J Cardiovasc Surg . 1990;31:357-358. 43. Staudacher M, Bardach G, Buchberger R, Holzner H. Tumoren der Carotisgabel . Aktuelle Chir . 1983;8:157-160. 44. Nora JD, Hallett JW, O'Brien PC, Naessens JM, Cherry KJ, Pairolero PC. Surgical resection of carotid body tumors: long-term survival, recurrence, and metastasis . Mayo Clin Proc . 1988;63:348-352.Crossref 45. Borges LF, Heros RC, DeBrun G. Carotid body tumors managed with preoperative embolization . J Neurosurg . 1983;59:867-870.Crossref 46. Schick PM, Hiesma GB, White RA, et al. Arterial catheter embolization followed by surgery for large chemodectoma . Surgery . 1980;84:459-464. 47. Richling B. Die präoperative endovaskuläre Embolisation mit homologem Fibrin . Fortschr Med . 1985;15:401-413. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430270065013
Publisher site
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Abstract

Abstract Objective: To determine the clinical characteristics of carotid body tumors to define better a standardized proceeding in the management of carotid body tumors. Design: Retrospective survey. Duration of postoperative follow-up was 4 months to 16 years (median, 57 months). Setting: Institutional, tertiary care medical center. Patients: Consecutive sample of 24 patients (10 men and 14 women) with 28 carotid body tumors treated in the University of Vienna (Austria) General Hospital in 35 years. Interventions: Surgical resection, preoperative embolization. Main Outcome Measures: Initial signs, duration of symptoms, extension of the tumors, methods of investigations, and treatment modality, with special respect to the operative technique. Results: Doppler color flow imaging and angiography provided essential mainstays for definite diagnosis. Computed tomography and magnetic resonance imaging contributed additional information about tumor extension. Nineteen patients (79%) underwent surgical resection of 22 tumors, 8 (42%) after preoperative embolization. There were no perioperative deaths. Hemiplegia occurred in 1 patient, and cranial nerve palsy occurred in 5 patients. Tumor recurrence was observed in 3 patients. Five patients refused surgery or tumors were unresectable. Conclusions: Our standard diagnostic procedure consists of establishing diagnosis by Doppler color flow sonography, angiography for detailing the vascularization of the tumor, and selective embolization to enable safer surgery with less bleeding. Early surgery is recommended to minimize major risks.Arch Surg. 1997;132:279-284 References 1. Williams PL, Warwick R, eds. Gray's Anatomy . 36th ed. New York, NY: Churchill Livingstone Inc; 1980:1462-1464. 2. Khan Q, Heath D, Smith P. Anatomical variations in human carotid bodies . J Clin Pathol . 1988;41:1196-1199.Crossref 3. Heath D. The human carotid body in health and disease . J Pathol . 1991;164: 1-8.Crossref 4. Glenner GG, Grimley PM. Tumors of the extra-adrenal paraganglion system (including chemoreceptors) . In: Atlas of Tumor Pathology . Washington, DC: Armed Forces Institute of Pathology; 1974;2( (pt 9) ):13-16. 5. Dunn GD, Brown MJ, Sapsford RN, et al. Functioning middle mediastinal paraganglioma (phaeochromocytoma) associated with intercarotid paragangliomas . Lancet . 1986;1:1061-1063.Crossref 6. Bernard RP. Carotid body tumors . Am J Surg . 1992;163:494-496.Crossref 7. Kliewer KE, Wen D, Cancilla PA, Cochran AJ. Paragangliomas: assessment of prognosis by histologic, immunohistochemical, and ultrastructural techniques . Hum Pathol . 1989;20:29-39.Crossref 8. Barnes L, Taylor SR. Carotid body paragangliomas: a clinicopathologic and DNA analysis of 13 tumors . Arch Otolaryngol Head Neck Surg . 1990;116:447-453.Crossref 9. Dickinson PH, Griffin SM, Guy AJ, McNeill IF. Carotid body tumour: 30 years experience . Br J Surg . 1986;73:14-16.Crossref 10. Staats EFN, Brown RL, Smith RR. Carotid body tumors, benign and malignant . Laryngoscope . 1966;76:907-916.Crossref 11. Gordon-Taylor G. On carotid tumours . Br J Surg . 1940;28:163-172.Crossref 12. Morfit HM, Swan H, Taylor ER. Carotid body tumors, report of 12 cases, including one case with proved visceral dissemination . Arch Surg . 1953;67:194-214.Crossref 13. Monro RS. The natural history of carotid body tumours and their diagnosis and treatment with a report of five cases . Br J Surg . 1950;37:445-453.Crossref 14. Martin HE. Surgery of Head and Neck Tumors . New York, NY: Paul B Hoeber Inc; 1957:20-80. 15. Williams MD, Phillips MJ, Nelson WR, Rainer WG. Carotid body tumor . Arch Surg . 1992;127:963-968.Crossref 16. McPherson GAD, Halliday AW, Mansfield AO. Carotid body tumours and other cervical paragangliomas: diagnosis and management in 25 patients . Br J Surg . 1989;76:33-36.Crossref 17. Meyer FB, Sundt TM, Pearson BW. Carotid body tumors: a subject review and suggested surgical approach . J Neurosurg . 1986;64:377-385.Crossref 18. Wilson H. Carotid body tumors . Surgery . 1966:59:483-493. 19. Shamblin WR, ReMine WH, Sheps SG, Harrison EG. Carotid body tumor (chemodectoma): clinicopathologic analysis of ninety cases . Am Surg . 1971;122: 732-739.Crossref 20. Derchi LE, Serafini G, Rabbia C, et al. Carotid body tumors: US evaluation . Radiology . 1992;182:457-459.Crossref 21. Delcker A, Diener HC, Müller RD, Haase R. Carotid body tumor: appearance on color-flow Doppler sonography . Vasa . 1991;20:280-282. 22. Gritzmann N, Herold C, Haller J, Karnel F, Schwaighofer B. Duplex sonography of tumors of the carotid body . Cardiovasc Intervent Radiol . 1987;10:280-284.Crossref 23. Worsey MJ, Laborde AL, Bower T, et al. An evaluation of color duplex scanning in the primary diagnosis and management of carotid body tumors . Ann Vasc Surg . 1992;6:90-94.Crossref 24. Steinke W, Hennerici M, Aulich A. Doppler color flow imaging of carotid body tumors . Stroke . 1989;20:1574-1577.Crossref 25. LaMuraglia GM, Fabian RL, Brewster DC, et al. The current surgical management of carotid body paragangliomas . J Vasc Surg . 1992;15:1038-1045.Crossref 26. Bishop GB, Urist MM, Gammal TE, Peters GE, Maddox WA. Paragangliomas of the neck . Arch Surg . 1992;127:1441-1445.Crossref 27. Iacconi P, Spinelli C, Cechini M, Ricci E, Berti P, Miccoli P. Carotid body tumours: a review of eight cases . Eur J Surg Oncol . 1992;18:93-97. 28. Rabl H, Friehs I, Gutschi S, Pascher O, Koch G. Diagnosis and treatment of carotid body tumors . Thorac Cardiovasc Surg . 1993;41:340-343.Crossref 29. Sanghvi VD, Chandawarkar RY. Carotid body tumors . J Surg Oncol . 1993;54: 190-192.Crossref 30. Laube HR, Fahrenkamp AG, Böcker W, Scheld HH. Glomustumoren: eine diagnostische und chirurgische Herausforderung? Z Kardiol . 1994;83:373-380. 31. Anand VK, Alemar GO, Sanders TS. Management of the internal carotid artery during carotid body surgery . Laryngoscope . 1995;105:231-235.Crossref 32. Matticari S, Credi G, Pratesi C, Bertini D. Diagnosis and surgical treatment of the carotid body tumors . J Cardiovasc Surg . 1995;36:233-239. 33. Olsen WC, Dillon WP, Kelly WM, Norman D, Brant-Zawadzki M, Newton TH. MR imaging of paragangliomas . AJR Am J Roentgenol . 1987;148:201-204.Crossref 34. Van Gils APG, van der Mey AGL, Hoogma RPLM, et al. MRI screening of kindred at risk of developing paragangliomas: support for genomic imprinting in hereditary glomus tumours . Br J Cancer . 1992;65:903-907.Crossref 35. Dent TL, Thompson NW, Fry WJ. Carotid body tumors . Surgery . 1976;80:365-372. 36. Van Gils APG, van der Mey AGOL, Hoogma RPLM, et al. I-123 metaiodobenzylguanidine scintigraphy in patients with chemodectomas of the head and neck region . J Nucl Med . 1990;31:1147-1155. 37. Ward PH, Liu C, Vinuela F, Bentson JR. Embolization: an adjunctive measure for removal of carotid body tumors . Laryngoscope . 1988;98:1287-1291.Crossref 38. Hallet JW Jr, Nora JD, Hollier LH, Cherry KJ, Pairolero PC. Trends in neuro-vascular complications of surgical management for carotid body and cervical paraganglioma: a 50-year experience with 153 tumors . J Vasc Surg . 1988;7: 284-291.Crossref 39. Daudi FA, Thurston OG. Carotid body tumours: the University of Alberta Hospital experience . Can J Surg . 1989;32:159-161. 40. Robison JG, Shagets FW. Beckett WC, Spies JB. A multidisciplinary approach to reducing morbidity and operative blood loss during resection of carotid body tumor . Surg Gynecol Obstet . 1989;168:166-167. 41. Kraus DH, Sterman BM, Hakaim AG, et al. Carotid body tumors . Arch Otolaryngol Neck Head Surg . 1990;116:1384-1387.Crossref 42. McCabe DP, Vaccaro PS, James AG. Treatment of carotid body tumors . J Cardiovasc Surg . 1990;31:357-358. 43. Staudacher M, Bardach G, Buchberger R, Holzner H. Tumoren der Carotisgabel . Aktuelle Chir . 1983;8:157-160. 44. Nora JD, Hallett JW, O'Brien PC, Naessens JM, Cherry KJ, Pairolero PC. Surgical resection of carotid body tumors: long-term survival, recurrence, and metastasis . Mayo Clin Proc . 1988;63:348-352.Crossref 45. Borges LF, Heros RC, DeBrun G. Carotid body tumors managed with preoperative embolization . J Neurosurg . 1983;59:867-870.Crossref 46. Schick PM, Hiesma GB, White RA, et al. Arterial catheter embolization followed by surgery for large chemodectoma . Surgery . 1980;84:459-464. 47. Richling B. Die präoperative endovaskuläre Embolisation mit homologem Fibrin . Fortschr Med . 1985;15:401-413.

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1997

References

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