1/161. Adjuvant techniques for the management of large carotid body tumors. A case report and review. Although the first successful resection of a carotid body tumor was reported over 100 years ago this operation remains technically challenging with many potential pitfalls. The case of a man with a large (8 cm) carotid body tumor will be presented in order to identify key issues that pertain to effective diagnostic and therapeutic modalities. A multidisciplinary team (vascular surgeon, neurosurgeon, neuroradiologist, interventional radiologist and oromaxillofacial surgeon) provided specific expertise on each aspect of the patient's evaluation and treatment. Adjuvant techniques employed in this case included angiographic tumor embolization, jaw subluxation, strap muscle division, nasotracheal intubation, carotid resection and saphenous vein interposition grafting. ( info) |
2/161. Removal of catecholamine-secreting chemodectoma. The use of neuroleptanaesthesia, adrenergic blockade and sodium nitroprusside. A case of catecholamine-secreting chemodectoma of the neck in a 47-year-old male who also had temporal lobe epilepsy is described. Details of presentation, diagnosis and successful treatment are given. He was fully alpha blocked with phenoxybenzamine and given neuroleptic drugs but his blood pressure rose to dangerous levels when the tumour was handled and did not respond to intravenous phentolamine. sodium nitroprusside was successfully used to achieve blood pressure control. ( info) |
3/161. Reversible sensorineural hearing impairment induced by a carotid body tumor. A case of a 62-year-old Austrian man having a 25-year history of a right-sided carotid body tumor (CBT) is presented. Three months before being transferred to the University of Vienna for tumor resection the patient developed symptoms of tinnitus, progressive ipsilateral hearing loss and dysphagia. Pure-tone audiometry demonstrated a 50 dB right sensorineural hearing loss. A 6 x 6 x 4 cm firm, pulsatile mass was found in the right carotid triangle and extending towards the base of the skull. One week after radical tumor resection all preoperative symptoms disappeared and hearing of the right ear recovered. review of the available literature showed that hearing loss and tinnitus are unusual symptoms of a CBT. Our findings suggest that routine audiometric evaluations in such cases of CBT patients should be obtained in order to determine the real incidence of audiological disorders. ( info) |
4/161. Diagnostic and therapeutic approaches to carotid body tumours: report of three cases and review of the literature. BACKGROUND: Carotid body tumour is a rare neoplasm of the carotid body. Three cases of carotid body tumour presenting as a painless progressive mass in the neck region are reported here. A review of the relevant literature regarding carotid body tumours is also presented. methods: Angiographic features were diagnostic of carotid body tumour and complete surgical excision was done. RESULTS: There was no mortality and minimum morbidity. There were no malignant tumours. All three patients belong to the high-altitude area of Himachal Pradesh. CONCLUSIONS: A high degree of clinical suspicion of upper posterior triangle neck masses and an accurate diagnostic work-up are needed for operative planning. ( info) |
5/161. Management of incidentally discovered cervical paragangliomas: report of two cases and review of current issues. Paragangliomas of the head and neck are uncommon neoplasms arising from the extra-adrenal paraganglia and include carotid body and glomus vagale tumors. These lesions may be discovered incidentally by imaging studies performed to evaluate carotid atherosclerotic occlusive disease. Incidental paragangliomas of the head and neck may be smaller than those discovered due to symptoms. Although surgical resection remains the definitive treatment for head and neck paragangliomas, important issues of management arise when such lesions are discovered. Two recent cases are reported. epidemiology, pathophysiology, diagnostic evaluation, and issues of management of head and neck paragangliomas are discussed. ( info) |
6/161. Bilateral carotid body paraganglioma: case report. CONTEXT: Surgical treatment of carotid body paragangliomas is a challenge to the surgeon because of the large vascularization of the tumor, involvement of the carotid vessels and the close anatomical relationship with the cranial nerves. CASE REPORT: A 63-year-old patient was submitted to resection of two carotid body paraganglioma tumors found in the right-side and left-side carotid bodies at the bifurcation of the common carotid arteries. Two surgeries were performed at different times and neither of them presented any morbidity. Arteriography was fundamental for diagnosis of the small, asymptomatic tumor on the right side. DESIGN: Case Report ( info) |
7/161. paraganglioma as a systemic syndrome: pitfalls and strategies. Tumours of the neuroendocrine system in the head and neck region are mostly paragangliomas of the glomus tympanicum or jugulare, or of the carotid body. The majority of these tumours are benign, and the coexistence of multiple paragangliomas seems to be rare. Pre-operative embolization and surgery are regarded as primary therapy for these tumours. The treatment regimen in any patient depends on age, general health, hearing status and the function of the lower cranial nerves. Several presentations are possible in which paragangliomas occur as systemic disease. 1. Paragangliomas may occur bilaterally, or, in rare cases, in multiple areas. Pre-operative bilateral angiography is of utmost importance. In case of multicentricity, it might be necessary to proceed without, or just with, unilateral surgery for preservation of adjacent structures. In surgery of jugular vein paraganglioma, we usually perform a modified transmastoidal and transcervical approach with preservation of middle-ear structures and the ossicles. As an alternative or supplement to surgery, radiotherapy or definitive embolization may be used in the treatment of paragangliomas. 2. Paragangliomas may occur as multiple endocrine neoplasia (men) syndrome combined with medullary thyroid gland carcinoma, and, facultatively, pheochromocytoma. In these cases, endocrinological examination and magnetic resonance imaging (MRI) of the adrenal region, the thorax and the neck are required for an adequate therapeutic strategy. As men may be inherited, family history should be evaluated. 3. Paragangliomas can became malignant and metastasize. Thus, cervical lymph node metastases or distant metastases may occur. We recommend the removal of all ipsilateral lymph nodes and their histological examination. ( info) |
8/161. Ectopic pheochromocytoma arising in the spermatic cord 5 years after removal of bilateral carotid body tumors and adrenal pheochromocytomas. A patient with ectopic pheochromocytoma that developed in the spermatic cord about 5 years after successive resections of bilateral carotid body tumors and bilateral adrenal pheochromocytomas is reported. This is thought to be the first case of pheochromocytoma of the spermatic cord in a setting of multiplicity. ( info) |
9/161. baroreflex failure syndrome after bilateral excision of carotid body tumors: an underestimated problem. Carotid body tumors (CBTs) are relatively rare paragangliomas that develop from neural crest cells at the bifurcation of the common carotid artery. They are generally slow growing and benign. Excision is currently considered the treatment of choice, although vascular and especially neural injuries are still relatively frequent in patients with large or bilaterally resected tumors. The baroreflex failure syndrome (BFS) has recently been identified as a severe, rarely recognized, and certainly underestimated complication after the bilateral excision of CBTs. The present report describes a case of a bilateral CBT followed by BFS and reviews the experiences reported in the literature. In light of the low incidence of malignancy of these tumors, their biologic behavior, their very high rate of cranial nerve palsy, and the occurrence of BFS in bilaterally resected paragangliomas, the current practice of bilaterally removing these tumors is questioned. ( info) |
| BACKGROUND: An extremely rare case of intracranial aneurysm associated with catecholamine-secreting carotid body tumor is presented. CASE DESCRIPTION: A 64-year-old woman suffering from hypertensive attacks was admitted first to the otolaryngology Department with a neck swelling. Right common carotid angiography revealed a hypervascular mass at the carotid bifurcation. On the same angiogram a middle cerebral artery aneurysm was discovered incidentally and the patient was referred to the Neurosurgical Department. Because of her history the tumor was considered to be endocrinologically active and the patient underwent alpha- and beta-blockade to protect intraoperative cardiovascular instability. Despite all precautions, during the operation hypertensive crises developed and the aneurysm was clipped with difficulty. CONCLUSION: Perioperative management designed to avoid complications in treating this rare association is discussed. Although this is the first reported case of an intracranial aneurysm associated with a functional carotid body tumor, a possible etiopathogenesis of the relationship between the aneurysm and hypertensive attacks due to an acute catecholamine-discharging tumor is presented. ( info) |