Carotid body tumor surgery
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Carotid body tumor surgery On the Web |
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Risk calculators and risk factors for Carotid body tumor surgery |
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]
- 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 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.
Indications
- Individuals with small to moderate-sized carotid body tumors and tympanic paragangliomas without cranial nerve dysfunction
- Younger and middle-aged patients without coexisting medical problems
- Individuals with a malignant tumor
- Postoperative radiation therapy is also should be considered.
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]
- Cranial nerve involvement in 10% to 56% of the cases.
- The most commonly involved nerves are such as:
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.[1][2][5]
- Also, studies have shown that the complications of radiotherapy are lower in comparison with surgery.
Indications for radiotherapy
Radiotherapy is indicated in:[2]
- Elderly individuals
- High-risk patients with multiple or severe medical conditions
- 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 multiple or bilateral tumors with the potential for severe postoperative debility from cranial nerve dysfunction
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
- ↑ 1.0 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.
- ↑ 2.0 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.
- ↑ Eisele, David (2008). Complications in head and neck surgery. Edinburgh: Saunders. ISBN 978-1-4160-4220-4.
- ↑ Eisele, David (2008). Complications in head and neck surgery. Edinburgh: Saunders. ISBN 978-1-4160-4220-4.
- ↑ 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.