Carotid body tumor surgery: Difference between revisions

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{{Carotid body tumor}}
{{Carotid body tumor}}
{{CMG}}; {{AE}} {{Sahar}}
{{CMG}}; {{AE}} {{Sahar}} {{MV}}


==Overview==
==Overview==
Traditionally, surgery is considered the mainstay of treatment for the carotid body tumor. However, there is a growing amount of studies observing that radiotherapy can be used as an alternative treatment with equal efficacy and lower complications.
Traditionally, [[surgery]] is considered the mainstay of [[treatment]] for the [[carotid body]] [[tumor]]. However, there is a growing amount of studies observing that [[radiotherapy]] can be used as an alternative treatment with equal [[efficacy]] and lower [[complications]].


==Surgery==
==Surgery==


Surgery is the treatment of choice for [[carotid body]] [[tumor]].<ref name="pmid23610583">{{cite journal |vauthors=Luo T, Zhang C, Ning YC, Gu YQ, Li JX, Wang ZG |title=Surgical treatment of carotid body tumor: case report and literature review |journal=J Geriatr Cardiol |volume=10 |issue=1 |pages=116–8 |date=March 2013 |pmid=23610583 |pmc=3627704 |doi=10.3969/j.issn.1671-5411.2013.01.018 |url=}}</ref>
[[Surgery]] is the treatment of choice for [[carotid body]] [[tumor]].<ref name="pmid23610583">{{cite journal |vauthors=Luo T, Zhang C, Ning YC, Gu YQ, Li JX, Wang ZG |title=Surgical treatment of carotid body tumor: case report and literature review |journal=J Geriatr Cardiol |volume=10 |issue=1 |pages=116–8 |date=March 2013 |pmid=23610583 |pmc=3627704 |doi=10.3969/j.issn.1671-5411.2013.01.018 |url=}}</ref>
*Surgical approach of the tumor is different for each Shamblin subclassification:
*[[Surgical]] approach of the [[tumor]] is different for each Shamblin subclassification:
**For Shamblin type I/II case without an abundant blood supply, simple resection of the tumor is the optimal treatment.
**For Shamblin type I/II case without an abundant [[blood]] supply, simple [[resection]] of the [[tumor]] is the optimal treatment.
**For Shamblin type III cases with large tumors and malignant tumors involving important peripheral vessels resection and reconstructive vascular operation (including simple vascular anastomosis, internal carotid artery-common carotid artery artificial and autologous reconstructive vascular operation) is appropriate.
**For Shamblin type III cases with large [[Tumor|tumors]] and [[malignant tumors]] involving important [[Peripheral vessel|peripheral vessels]] [[resection]] and [[reconstructive]] [[vascular]] operation (including simple [[vascular]] [[anastomosis]], [[internal carotid artery]]-[[common carotid artery]] artificial and autologous [[reconstructive]] [[vascular]] operation) is appropriate.


==Indications==
==Indications==
Surgery is indicated in:<ref name="pmid12886866">{{cite journal |vauthors=Hu K, Persky MS |title=Multidisciplinary management of paragangliomas of the head and neck, Part 1 |journal=Oncology (Williston Park, N.Y.) |volume=17 |issue=7 |pages=983–93 |date=July 2003 |pmid=12886866 |doi= |url=}}</ref>
[[Surgery]] is [[indicated]] in:<ref name="pmid12886866">{{cite journal |vauthors=Hu K, Persky MS |title=Multidisciplinary management of paragangliomas of the head and neck, Part 1 |journal=Oncology (Williston Park, N.Y.) |volume=17 |issue=7 |pages=983–93 |date=July 2003 |pmid=12886866 |doi= |url=}}</ref>
*Individuals with small to moderate-sized carotid body tumors and tympanic paragangliomas without cranial nerve dysfunction
*Individuals with small to moderate-sized [[carotid body]] [[Tumor|tumors]] and tympanic [[paragangliomas]] without [[cranial nerve]] [[dysfunction]]
*Younger and middle-aged patients without coexisting medical problems
*Younger and middle-aged patients without coexisting [[medical]] problems
*Individuals with a malignant tumor
*Individuals with a [[malignant]] [[tumor]]
**Postoperative radiation therapy is also should be considered.
**Postoperative [[radiation therapy]] is also should be considered.
==Contraindications==
==Contraindications==
Individuals who are poor candidates of surgery due to any reason.<ref>{{cite book | last = Eisele | first = David | title = Complications in head and neck surgery | publisher = Saunders | location = Edinburgh | year = 2008 | isbn = 978-1-4160-4220-4 }}</ref>
Individuals who are poor candidates of [[surgery]] due to any reason.<ref>{{cite book | last = Eisele | first = David | title = Complications in head and neck surgery | publisher = Saunders | location = Edinburgh | year = 2008 | isbn = 978-1-4160-4220-4 }}</ref>


==Complications of surgery==
==Complications of surgery==
Surgical excision of the tumor may be complicated by:
[[Surgical]] [[excision]] of the [[tumor]] may be [[Complications|complicated]] by:<ref>{{cite book | last = Eisele | first = David | title = Complications in head and neck surgery | publisher = Saunders | location = Edinburgh | year = 2008 | isbn = 978-1-4160-4220-4 }}</ref>
*Cranial nerve involvement in 10% to 56% of the cases.
*[[Cranial nerve]] involvement in 10% to 56% of the cases.
*The most commonly involved nerves are such as:
*The most commonly involved [[nerves]] are such as:
**The hypoglossal nerve
**[[Hypoglossal nerve]]
**The superior laryngeal nerve
**[[Superior laryngeal nerve]]
**The vagus nerve,
**[[Vagus nerve]]
**The mandibular branch of the facial nerve
**[[Mandibular branch]] of the [[facial nerve]]
**The pharyngeal branch of the vagus nerve
**[[Pharyngeal branch]] of the [[vagus nerve]]
**The glossopharyngeal nerve
**[[Glossopharyngeal nerve]]
**The spinal accessory nerve
**[[Spinal accessory nerve]]
**The sympathetic chain
**[[Sympathetic chain]]
 
==Radiotherapy==
==Radiotherapy==
*Although previous literature claimed that radiotherapy is not effective for the treatment of the tumor, current studies have shown that the efficacy is comparable to those of the surgery.<ref name="pmid23610583">{{cite journal |vauthors=Luo T, Zhang C, Ning YC, Gu YQ, Li JX, Wang ZG |title=Surgical treatment of carotid body tumor: case report and literature review |journal=J Geriatr Cardiol |volume=10 |issue=1 |pages=116–8 |date=March 2013 |pmid=23610583 |pmc=3627704 |doi=10.3969/j.issn.1671-5411.2013.01.018 |url=}}</ref><ref name="pmid12886866">{{cite journal |vauthors=Hu K, Persky MS |title=Multidisciplinary management of paragangliomas of the head and neck, Part 1 |journal=Oncology (Williston Park, N.Y.) |volume=17 |issue=7 |pages=983–93 |date=July 2003 |pmid=12886866 |doi= |url=}}</ref><ref name="SuárezRodrigo2013">{{cite journal|last1=Suárez|first1=Carlos|last2=Rodrigo|first2=Juan P.|last3=Mendenhall|first3=William M.|last4=Hamoir|first4=Marc|last5=Silver|first5=Carl E.|last6=Grégoire|first6=Vincent|last7=Strojan|first7=Primož|last8=Neumann|first8=Hartmut P. H.|last9=Obholzer|first9=Rupert|last10=Offergeld|first10=Christian|last11=Langendijk|first11=Johannes A.|last12=Rinaldo|first12=Alessandra|last13=Ferlito|first13=Alfio|title=Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy|journal=European Archives of Oto-Rhino-Laryngology|volume=271|issue=1|year=2013|pages=23–34|issn=0937-4477|doi=10.1007/s00405-013-2384-5}}</ref>
*Although previous literature claimed that [[radiotherapy]] is not effective for the treatment of the [[tumor]], current studies have shown that the [[efficacy]] is comparable to those of the [[surgery]].<ref name="pmid23610583">{{cite journal |vauthors=Luo T, Zhang C, Ning YC, Gu YQ, Li JX, Wang ZG |title=Surgical treatment of carotid body tumor: case report and literature review |journal=J Geriatr Cardiol |volume=10 |issue=1 |pages=116–8 |date=March 2013 |pmid=23610583 |pmc=3627704 |doi=10.3969/j.issn.1671-5411.2013.01.018 |url=}}</ref><ref name="pmid12886866">{{cite journal |vauthors=Hu K, Persky MS |title=Multidisciplinary management of paragangliomas of the head and neck, Part 1 |journal=Oncology (Williston Park, N.Y.) |volume=17 |issue=7 |pages=983–93 |date=July 2003 |pmid=12886866 |doi= |url=}}</ref><ref name="SuárezRodrigo2013">{{cite journal|last1=Suárez|first1=Carlos|last2=Rodrigo|first2=Juan P.|last3=Mendenhall|first3=William M.|last4=Hamoir|first4=Marc|last5=Silver|first5=Carl E.|last6=Grégoire|first6=Vincent|last7=Strojan|first7=Primož|last8=Neumann|first8=Hartmut P. H.|last9=Obholzer|first9=Rupert|last10=Offergeld|first10=Christian|last11=Langendijk|first11=Johannes A.|last12=Rinaldo|first12=Alessandra|last13=Ferlito|first13=Alfio|title=Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy|journal=European Archives of Oto-Rhino-Laryngology|volume=271|issue=1|year=2013|pages=23–34|issn=0937-4477|doi=10.1007/s00405-013-2384-5}}</ref>
*Also, studies have shown that the complications of radiotherapy are lower in comparison with surgery.
*Also, studies have shown that the [[complications]] of [[radiotherapy]] are lower in comparison with [[surgery]].


==Indications for radiotherapy==
==Indications for radiotherapy==
Radiotherapy is indicated in:<ref name="pmid12886866">{{cite journal |vauthors=Hu K, Persky MS |title=Multidisciplinary management of paragangliomas of the head and neck, Part 1 |journal=Oncology (Williston Park, N.Y.) |volume=17 |issue=7 |pages=983–93 |date=July 2003 |pmid=12886866 |doi= |url=}}</ref>
[[Radiotherapy]] is [[Indication (medicine)|indicated]] in:<ref name="pmid12886866">{{cite journal |vauthors=Hu K, Persky MS |title=Multidisciplinary management of paragangliomas of the head and neck, Part 1 |journal=Oncology (Williston Park, N.Y.) |volume=17 |issue=7 |pages=983–93 |date=July 2003 |pmid=12886866 |doi= |url=}}</ref>
*Elderly individuals
*Elderly individuals
*High-risk patients with multiple or severe medical conditions
*High-risk patients with multiple or severe [[medical conditions]]
*Individuals with extensive skull-base or intracranial involvement
*Individuals with extensive [[skull]]-base or intracranial involvement
*Individuals with concurrent jugular or vagal paragangliomas and no evidence of lower cranial nerve dysfunction
*Individuals with concurrent [[jugular]] or [[vagal]] [[paragangliomas]] and no evidence of lower [[cranial nerve]] [[dysfunction]]
*Individuals with multiple or bilateral tumors with the potential for severe postoperative debility from cranial nerve dysfunction
*Individuals with multiple or [[bilateral]] [[tumors]] with the potential for severe postoperative debility from [[cranial nerve]] [[dysfunction]]


==Observation==
==Observation==
Another policy in approaching carotid body tumor is observation. There is limited data regarding this policy, however, some studies recommended this policy considering the benign nature of the tumor and its slow growth nature.<ref name="SuárezRodrigo2013">{{cite journal|last1=Suárez|first1=Carlos|last2=Rodrigo|first2=Juan P.|last3=Mendenhall|first3=William M.|last4=Hamoir|first4=Marc|last5=Silver|first5=Carl E.|last6=Grégoire|first6=Vincent|last7=Strojan|first7=Primož|last8=Neumann|first8=Hartmut P. H.|last9=Obholzer|first9=Rupert|last10=Offergeld|first10=Christian|last11=Langendijk|first11=Johannes A.|last12=Rinaldo|first12=Alessandra|last13=Ferlito|first13=Alfio|title=Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy|journal=European Archives of Oto-Rhino-Laryngology|volume=271|issue=1|year=2013|pages=23–34|issn=0937-4477|doi=10.1007/s00405-013-2384-5}}</ref>
Another policy in approaching [[carotid body]] [[tumor]] is observation. There is limited data regarding this policy, however, some studies recommended this policy considering the [[benign]] nature of the [[tumor]] and its slow growth nature.<ref name="SuárezRodrigo2013">{{cite journal|last1=Suárez|first1=Carlos|last2=Rodrigo|first2=Juan P.|last3=Mendenhall|first3=William M.|last4=Hamoir|first4=Marc|last5=Silver|first5=Carl E.|last6=Grégoire|first6=Vincent|last7=Strojan|first7=Primož|last8=Neumann|first8=Hartmut P. H.|last9=Obholzer|first9=Rupert|last10=Offergeld|first10=Christian|last11=Langendijk|first11=Johannes A.|last12=Rinaldo|first12=Alessandra|last13=Ferlito|first13=Alfio|title=Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy|journal=European Archives of Oto-Rhino-Laryngology|volume=271|issue=1|year=2013|pages=23–34|issn=0937-4477|doi=10.1007/s00405-013-2384-5}}</ref>


==Algorithm for treatment==
==Algorithm for treatment==


{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | A01 | | | | |A01= [[Carotid body paraganglioma]]}}
{{Family tree | | | | | | | | | | | | | A01 | | | | |A01= [[Carotid body]] [[paraganglioma]]}}
{{Family tree | | | | | | | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | | | | | | | B01 | | | |B01= [[Malignant]]}}
{{Family tree | | | | | | | | | | | | | B01 | | | |B01= [[Malignant]]}}
Line 58: Line 59:
{{Family tree | | | | | | | | | | C01 | | | | C02 |C01= No| C02= Yes}}
{{Family tree | | | | | | | | | | C01 | | | | C02 |C01= No| C02= Yes}}
{{Family tree | | | | | | | | | | |!| | | | | |!| | }}
{{Family tree | | | | | | | | | | |!| | | | | |!| | }}
{{Family tree | | | | | | | | | | D01 | | | | |!| |D01= [[Signs]] and [[symptoms]] of secreting tumor}}
{{Family tree | | | | | | | | | | D01 | | | | |!| |D01= [[Signs]] and [[symptoms]] of secreting [[tumor]]}}
{{Family tree | | | | | | | | | | |!| | | | | |!| | }}
{{Family tree | | | | | | | | | | |!| | | | | |!| | }}
{{Family tree | | | | | | | |,|-|-|^|-|-|.| | |!| | }}
{{Family tree | | | | | | | |,|-|-|^|-|-|.| | |!| | }}
Line 78: Line 79:
{{Family tree/end}}
{{Family tree/end}}


The above algorithm is adopted from European Archive of Otorhinolaryngology.<ref name="SuárezRodrigo2013">{{cite journal|last1=Suárez|first1=Carlos|last2=Rodrigo|first2=Juan P.|last3=Mendenhall|first3=William M.|last4=Hamoir|first4=Marc|last5=Silver|first5=Carl E.|last6=Grégoire|first6=Vincent|last7=Strojan|first7=Primož|last8=Neumann|first8=Hartmut P. H.|last9=Obholzer|first9=Rupert|last10=Offergeld|first10=Christian|last11=Langendijk|first11=Johannes A.|last12=Rinaldo|first12=Alessandra|last13=Ferlito|first13=Alfio|title=Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy|journal=European Archives of Oto-Rhino-Laryngology|volume=271|issue=1|year=2013|pages=23–34|issn=0937-4477|doi=10.1007/s00405-013-2384-5}}</ref>
The above algorithm is adopted from European Archive of [[Otorhinolaryngology]].<ref name="SuárezRodrigo2013">{{cite journal|last1=Suárez|first1=Carlos|last2=Rodrigo|first2=Juan P.|last3=Mendenhall|first3=William M.|last4=Hamoir|first4=Marc|last5=Silver|first5=Carl E.|last6=Grégoire|first6=Vincent|last7=Strojan|first7=Primož|last8=Neumann|first8=Hartmut P. H.|last9=Obholzer|first9=Rupert|last10=Offergeld|first10=Christian|last11=Langendijk|first11=Johannes A.|last12=Rinaldo|first12=Alessandra|last13=Ferlito|first13=Alfio|title=Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy|journal=European Archives of Oto-Rhino-Laryngology|volume=271|issue=1|year=2013|pages=23–34|issn=0937-4477|doi=10.1007/s00405-013-2384-5}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category: Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Vascular medicine]]
[[Category:Surgery]]
[[Category:Otolaryngology]]
[[Category:Neurosurgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Vascular medicine]]
[[Category:Surgery]]
[[Category:Surgery]]

Latest revision as of 20:49, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Maria Fernanda Villarreal, M.D. [3]

Overview

Traditionally, surgery is considered the mainstay of treatment for the carotid body tumor. However, there is a growing amount of studies observing that radiotherapy can be used as an alternative treatment with equal efficacy and lower complications.

Surgery

Surgery is the treatment of choice for carotid body tumor.[1]

Indications

Surgery is indicated in:[2]

Contraindications

Individuals who are poor candidates of surgery due to any reason.[3]

Complications of surgery

Surgical excision of the tumor may be complicated by:[4]

Radiotherapy

Indications for radiotherapy

Radiotherapy is indicated in:[2]

Observation

Another policy in approaching carotid body tumor is observation. There is limited data regarding this policy, however, some studies recommended this policy considering the benign nature of the tumor and its slow growth nature.[5]

Algorithm for treatment

 
 
 
 
 
 
 
 
 
 
 
 
Carotid body paraganglioma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Malignant
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signs and symptoms of secreting tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Possibilites of bilateral/multiple tumors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low risk of cranial nerve injury
favorable for surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Age< 40
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Observation
 
Radiotherapy
 
 
Surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

The above algorithm is adopted from European Archive of Otorhinolaryngology.[5]

References

  1. ↑ 1.0 1.1 Luo T, Zhang C, Ning YC, Gu YQ, Li JX, Wang ZG (March 2013). "Surgical treatment of carotid body tumor: case report and literature review". J Geriatr Cardiol. 10 (1): 116–8. doi:10.3969/j.issn.1671-5411.2013.01.018. PMC 3627704. PMID 23610583.
  2. ↑ 2.0 2.1 2.2 Hu K, Persky MS (July 2003). "Multidisciplinary management of paragangliomas of the head and neck, Part 1". Oncology (Williston Park, N.Y.). 17 (7): 983–93. PMID 12886866.
  3. ↑ Eisele, David (2008). Complications in head and neck surgery. Edinburgh: Saunders. ISBN 978-1-4160-4220-4.
  4. ↑ Eisele, David (2008). Complications in head and neck surgery. Edinburgh: Saunders. ISBN 978-1-4160-4220-4.
  5. ↑ 5.0 5.1 5.2 Suárez, Carlos; Rodrigo, Juan P.; Mendenhall, William M.; Hamoir, Marc; Silver, Carl E.; Grégoire, Vincent; Strojan, Primož; Neumann, Hartmut P. H.; Obholzer, Rupert; Offergeld, Christian; Langendijk, Johannes A.; Rinaldo, Alessandra; Ferlito, Alfio (2013). "Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy". European Archives of Oto-Rhino-Laryngology. 271 (1): 23–34. doi:10.1007/s00405-013-2384-5. ISSN 0937-4477.
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