Tumor de cuerpo carotídeo en adolescente. Reporte de un caso / Carotid body tumor in an adolescent. A case report

Introducción. Los paragangliomas del cuerpo carotídeo son neoplasias infrecuentes y representan el 0,6 % de los tumores de cabeza y cuello. La edad de presentación promedio es la quinta década de vida. El objetivo de este artículo fue describir un caso de paraganglioma del cuerpo carotídeo en una adolescente. Caso clínico. Se presenta el caso de una paciente adolescente con paraganglioma de cuerpo carotídeo derecho, de 5x3x3 cm, Shamblin III. Se analizaron la historia clínica, los exámenes diagnósticos, la técnica quirúrgica utilizada y su evolución correspondiente. La información fue obtenida a partir de la ficha clínica, previa autorización por consentimiento de los padres de la paciente. Resultados. Se hizo resección quirúrgica completa y reparo vascular con injerto de vena safena invertida, con evolución favorable y permeabilidad completa del puente vascular, sin secuelas. Conclusión. Este caso podía corresponder a un tumor de etiología familiar, dada su edad temprana de presentación. Se hizo necesario complementar su estudio con imágenes y objetivar el compromiso vascular asociado para la planificación quirúrgica. En estos pacientes, la complejidad de su localización y el compromiso vascular del tumor requiere de un equipo multidisciplinario, con cirujanos de cabeza y cuello y cirujanos vasculares para un resultado exitoso.

Introduction. Carotid body paragangliomas are rare, representing 0.6% of head and neck tumors, with average age of presentation in the fifth decade of life. The objective of this article is to describe a clinical case of carotid body paraganglioma in an adolescent. Clinical case. Review and analysis of the clinical case, reviewing its clinical history, study tests, surgical technique used and its corresponding evolution. Information obtained from the clinical record prior authorization by consent of the patient's parents. Results. Adolescent patient with paraganglioma of the right carotid body, 5x3x3 cm, Shamblin III. With complete surgical resection and inverted saphenous vein graft, favorable evolution, with complete permeability of the vascular bridge, without sequelae. Conclusion. This case could correspond to a tumor of familiar etiology, given its early age of presentation. It is necessary to complement the study with images and to objectively determine the associated vascular involvement for surgical planning. In these patients, the complexity of their location and vascular involvement of the tumor requires a multidisciplinary team with head and neck and vascular surgeons for a successful outcome.

Paraganglioma gigante del espacio parafaríngeo en una fémina / Giant paraganglioma of the parapharingeal space in a woman: en

Se describe el caso clínico de una paciente de 57 años de edad, con antecedente de hipertensión arterial, quien fue asistida en el Servicio de Cirugía de Cabeza y Cuello del Instituto Nacional de Oncología y Radiobiología de La Habana, remitida de la consulta de Otorrinolaringología de su hospital de cabecera por presentar manifestaciones clínicas de disfagia y diagnóstico clínico de sospecha de un paraganglioma carotídeo. Luego de realizados el examen físico y los estudios complementarios pertinentes, el caso fue discutido por los integrantes de un equipo multidisciplinario y se confirmó la existencia de un paraganglioma del espacio parafaríngeo, por lo que se decidió realizar tratamiento quirúrgico. La evolución fue satisfactoria y a los 2 años del procedimiento quirúrgico no presentaba secuelas.

The case report of a 57 years patient with history of hypertension is described who was assisted in the Head and Neck Surgery Service of the National Institute of Oncology and Radiobiology in Havana, referred from the Otolaryngology Service of her head hospital due to clinical manifestations of dysphagia and suspected clinical diagnosis of a carotid paraganglioma. After the physical exam and the pertinent complementary studies, the case was discussed by the members of a multidisciplinary team and the existence of a paraganglioma in the parapharingeal space was confirmed, therefore it was decided to carry out surgical treatment. The clinical course was satisfactory, and 2 years after the surgical procedure there were no sequels.

Luschka and the carotid body / Luschka e o corpo carotídeo

The 'carotid body' is a small structure sited at the bifurcation of the common carotid artery. The macroscopic features of the carotid body, and items of the extrinsic nervous, and vascular supplies, were initially described by Taube (1743), complemented by a number of authors that followed, proceeding until Luschka (1962), who added the first microscopic study. The macroscopic features of the carotid body, including location, extrinsic innervation, and vascular supply, then provided, were described in a relatively satisfactory manner. However, despite Luschka's great and admirable effort, the microscopic findings seem to be flawed, what can be ascribed to the technical limitations at the time, and the artifacts due to the used procedures. Nevertheless, there is no doubt that Luschka and his forerunners provided an important step for forthcoming research on the carotid body, and its innervation.

O 'corpo carotídeo' é uma pequena estrutura situada na bifurcação da artéria carótida comum. Os aspectos macroscópicos do corpo carotídeo e itens sobre o suprimento nervoso e vascular extrínsecos foram descritos inicialmente por Taube (1743), complementados por um certo número de autores que seguiram, prosseguindo até Luschka (1962), que acrescentou o primeiro estudo microscópico. Os aspectos macroscópicos do corpo carotídeo, incluindo localização, inervação extrínseca e suprimento vascular, então providos, foram descritos de modo relativamente satisfatório. Entretanto, apesar do grande e admirável esforço de Luschka, os achados microscópicos aparecem falhos, o que pode ser atribuído às limitações técnicas daquele tempo e a artefatos devidos aos procedimentos utilizados. Todavia, não há dúvida que Luschka e seus precursores proveram um importante passo para pesquisas que vieram sobre o corpo carotídeo e da sua inervação.

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.

Paraganglioma del cuerpo carotídeo asociado a un adenoma paratiroideo: reporte de caso

Introducción: Los paragangliomas son tumores raros, y más raros aun cuando se presentan con otros tumores endocrinos. Objetivo: Presentar el caso de un paraganglioma del cuerpo carotídeo asociado con adenomas paratiroideos. Materiales y Método: Se presenta la evaluación clínica, imagenológica y fotográfica del caso. Resultados: Se presenta el caso de una paciente de 34 años con una masa cervical en región cervical de un año de evolución y que, durante los estudios de extensión, se encontró que correspondía a un paraganglioma en la bifurcación carotídea izquierda, asociada además con dos adenomas paratiroideos, que fueron resecados sin complicaciones. Discusión: Se discute la fisiopatología, el diagnóstico y manejo en relación con el caso presentado. Conclusión: La presentación de paragangliomas del cuerpo carotídeo asociadas con adenomas paratiroideos es rara, y su evaluación clínica deberá ser individualizada, dado que, si bien el manejo será en su mayoría quirúrgico, el abordaje dependerá de cada caso.

Introduction: Paragangliomas are rare tumors, and they are even rarer when they present with other endocrine tumors. Aim: To present a clinical case of a carotid body paraganglioma associated with parathyroid adenomas. Materials and Method: There are shown the clinical evaluation, images, and photos of the case. Results: We present the case of a 34 years old female patient with a cervical mass, which has grown for a year, and, after extension studies, it was found that the mass corresponded to a paraganglioma located in the left carotid bifurcation, and it was associated with two parathyroid adenomas, all the neoplasms were resected with no complications. Discussion: It is discussed physiopathology, diagnosis and management based on the presented case Conclusion: Carotid body paragangliomas associated with parathyroid adenomas are rare, and the clinical evaluation must be individual, given that, most of the management is surgical, however, the approach will depend on each case.

Clinical experience of diagnosis and treatment of carotid body tumor / 国际外科学杂志

Objective:To investigate the clinical characteristics and surgical treatment experience of carotid body tumor (CBT).Methods:The clinical data of 12 patients with CBT admitted to the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University from March 2013 to August 2020 were analyzed retrospectively. Among them, there were 6 males and 6 females, aged 31-83 years, with a median age of 57 years. Among the 12 patients, 2 patients were not treated surgically. The body mass index (BMI), tumor side, maximum diameter of tumor, and tumor classification, operation time, intraoperative bleeding volume, postoperative drainage volume and time, postoperative hospital stay and postoperative complications of patients undergoing surgery were recorded.Results:BMI of the 12 patients was 17.19-29.07 kg/m 2, with an average of (24.05±3.95) kg/m 2. Among the 12 patients, there were 4 tumors on the left side, 6 tumors on the right side and 2 patients had bilateral tumors. The maximum diameter of the tumor was 1.7-8.7 cm, with an average of (4.05 ± 1.89) cm. Among the 2 patients with bilateral tumors, 1 patient underwent staged resection within 9 months and 1 patient only removed the larger tumor. A total of 10 patients underwent surgical resection. All excised tumors were confirmed histopathologically to be paraganglioma. The average operation time and the amount of bleeding was(164.73 ± 74.39)min and 341.82 mL respectively. The drainage time was 1-3 d, with an average of (1.73 ± 0.65) d. The cumulative drainage volume was 22-237 mL, with an average of (77.18 ± 57.47) mL. Classification of 11 surgically resected tumors: 3 patients (3/11, 27.3%) were Shamblin Ⅰ, 7 patients (7/11, 63.6%) were Shamblin Ⅱ and 1 patient (1/11, 9.1%) were Shamblin Ⅲ. There were 1 patient of hematoma and 1 patient of acute cerebral infarction after operation. One patient with decrease in muscle strength of right limb, other surgical patients complained no complications such as stroke and cranial nerve injury when discharged. Patients undergoing surgery were hospitalized for 8-20 days, with an average of (13.36 ± 3.61) d. Conclusions:CBT is a rare paraganglioma in clinic. Surgical resection is an effective method to treat CBT. Careful operation should be carried out to avoid serious complications such as wound hematoma, cranial nerve injury and ischemic stroke.

Surgical experience and risk factors of 133 cases of carotid body tumor / 中华普通外科杂志

Objective:To summarize the surgical experience of carotid body tumor (CBT)and analyze the risk factors.Methods:The clinical and follow-up data of 133 patients with carotid body tumor undergoing surgery at the First Medical Center of PLA General Hospital from Nov 2005 to Apr 2019 were retrospectively analyzed.Results:All of 142 tumors were successfully resected. No patients died perioperatively. Thirty-three (23.2%) cases underwent simple tumor resection, 82 (57.8%) cases underuent tumor resection combined with external carotid artery ligation, 13 (9.2%) cases did internal carotid artery reconstruction, 10 (7.0%) cases had total or external carotid artery repairment, and 4 (2.8%) cases underwent total or internal carotid artery ligation. There were 53 complications, including 43 cases of cranial nerve injury, with an average operating time of 161min (60-500 min), an average blood loss of 308 ml (20-3 000 ml). The follow-up time ranged from 1 to 162 months. No death occurred during the follow-up period.Conclusions:Tumor size and Shamblin typing are surgical risk factors. Most of ShamblinⅠtype tumor can do simple resection, but type Ⅱ and Ⅲ often need to ligate the external carotid artery. Use of great saphenous vein has a favorable long-term patency rate.

The advantages of ulthera assisted resection of carotid body tumors / 中华普通外科杂志

Objective:To evaluate the use of ulthera in carotid body tumor resectionMethods:From Jun 2004 to Jun 2019 at the First Hospital of China Medical University. Forty-three shamblin grade Ⅱ or Ⅲ patients were retrospectively assigned to ulthera assisted carotid body tumor resection (26 cases) and traditional carotid body tumor resection (17 cases).Results:In ulthera assisted group, the average tumor diameter was (4.0±0.6) cm, compared to (3.9±0.9) cm in traditional carotid body tumor surgery group, P=0.875. The operation time of the two group was respectively (117.6±39.8) min and (149.4±55.0) min ( P=0.005), blood loss (145.7±70.6) ml vs. (194.1±80.7) ml ( P=0.006), hospital stay was (16.8±7.5) d vs. (22.7±13.0) d ( P=0.017), and following-up period was between 6 and 180 months. One patient relapsed in ulthera assisted group. The postoperative complications occurred in 8 and 7 cases respectively. Conclusion:Ulthera assisted carotid body tumor resection helps shorten operation time, hospital stay and decrease intraoperative blood loss.

Risk Factors for Patients Using Intraoperative Vasopressor Infusions During Carotid Body Tumor Excision / 中国医学科学院学报

Objective To investigate the risk factors for patients using intraoperative vasopressor infusions during carotid body tumor(CBT)excision.Patients' mean arterial pressure(MAP)and heart rate(HR)fluctuations as well as their requirements for vasoactive agents during surgery were assessed. Methods The patients receiving CBT excision in Peking Union Medical College Hospital from May 1,2013 to July 31,2017 were included for a retrospective cohort study.The potential factors of intraoperative requirement for vasopressor infusions were investigated using univariate analysis and Logistic multivariate analysis.Furthermore,the relationships of Shamblin types of CBT with intraoperative MAP/HR fluctuations and requirements for vasoactive agents were analyzed. Results A total of 108 patients with 116 CBTs were included.Univariate analysis revealed that maximum tumor diameter >4 cm,intraoperative internal carotid artery injury,internal carotid artery reconstruction,malignant pathology,advanced Shamblin types(type Ⅱ and Ⅲ),estimated blood loss ≥400 ml,and operation duration >4 hours were associated with intraoperative requirements for vasopressor infusions.Logistic analysis showed that Shamblin type Ⅲ(OR=2.286,95% CI=1.324-14.926,P=0.016)and operation duration >4 hours(OR=3.874,95% CI=1.020-14.623,P=0.046)were risk factors for intraoperative requirements for vasopressor infusions during CBT surgery.In addition,Shamblin type Ⅲ was associated with intraoperative abnormal HR elevation and requirements for vasopressors.Conclusions Shamblin type Ⅲ and operation duration>4 hours are risk factors for intraoperative requirements of patients for using vasopressor infusions during CBT surgery.Shamblin type Ⅲ is associated with intraoperative abnormal HR elevation and requirements for vasopressors.

Progress in the diagnosis and treatment of carotid body tumor / 国际外科学杂志

Carotid body tumor is a chemoreceptor tumor originated from the carotid body. It is the most common paraganglioma in the head and neck with special location, abundant blood supply and close relationship with carotid artery and peripheral nerves. Therefore, carotid body tumor has the characteristics of difficult diagnosis, lack of specificity and high risk of operation. This article reviews the progress in the diagnosis and treatment of carotid body tumor.

Propuesta de clasificación tomográfica preoperatoria para el tumor del cuerpo carotideo / Proposal for a preoperative tomographic classification for carotid body tumor

OBJETIVO: proponer una clasificación preoperatoria a los pacientes con tumor de cuerpo Carotídeo y relacionarlos con complicaciones postoperatorias. MATERIAL Y MÉTODOS: todos los pacientes operados con diagnóstico de tumor del cuerpo Carotídeo entre el 2005 al 2014 en el Hospital Obrero N° 1 de la Caja Nacional de Salud en La Paz - Bolivia RESULTADOS: se analizaron y operaron 115 pacientes con un promedio de edad de 52 años (DE±11,725 y una moda de 57 años) de los cuales el 109 (94,80%) correspondieron al género femenino con una razón de 18:1. Todos los pacientes eran originarios y residentes de ciudades ubicadas a más de 2500 m.s.n.m. El promedio de evolución fue de 3 años (DE±2,189), y solo 7 pacientes (6,1%) presentan hábito tabáquico. 83 pacientes (72,2%) de los TCC se localizan en el lado izquierdo En las manifestaciones clínicas, todos los pacientes presentan el tumor localizado en el ángulo mandibular, por delante del musculo esternocleidomastoideo, describiéndose un crecimiento paulatino y permanente en 72 sujetos (62,6%), cefalea en 45 (39,1%), presencia de latido en 30 sujetos (26,1%), disfagia en 9 (7,9%), mareos en 16 (13,9%) y disfonía en 6 (5,2%). Entre los signos más evidentes de TCC, se describe el signo de Fontaine en 114 sujetos (99,2%), adenomegalia en 20 (17,4%) y otros menos frecuentes como soplo, abombamiento parafaringeo y compromiso de pares craneales. Todos los pacientes fueron clasificados en ambos sistemas (Shamblin y la nuestra llamada de los Andes). Se describen 39 pacientes (33,2%) con complicaciones postoperatorias, Grado I: 1 paciente sin complicaciones; Grado II: de 58 sujetos, 4 (3,5%) presentaban parálisis temporal del Hipogloso; en el Grado III: de los 41 sujetos, 24 (20,8%) presentaron ligadura de la arteria carótida externa, parálisis del hipogloso y glosofaringeo, lesión de recurrente y del laríngeo superior. En el grupo IV, de los 15 sujetos operados, 11 presentaron complicaciones (9,6% del total y 73% del grupo) entre las cuales están ligadura de la arteria carótida externa, lesión del hipogloso y un paciente con AVC y hemiparesia. Se describe una reoperación (0,86%) y ninguna mortalidad. CONCLUSIÓN: proponer una clasificación preoperatoria que tenga la posibilidad de asociarse a complicaciones y pronóstico.

OBJECTIVE: to propose a preoperative classification of patients with Carotid Body Tumor and relate them to postoperative complications. MATERIAL AND METHODS: all patients operated with a diagnosis of Carotid Body Tumor between 2005 and 2014 at the Obrero Hospital No. 1 of the National Health Fund in La Paz - Bolivia RESULTS: 115 patients with an average age of 52 years (SD±11.725 and a mode of 57 years) were analyzed and operated on, of which 109 (94.80%) corresponded to the female gender with a ratio of 18: 1. All the patients were from and residents of cities located more than 2,500 meters above sea level. The mean evolution was 3 years (SD±2.189), and only 7 patients (6.1%) had a smoking habit. 83 patients (72.2%) of CBTs are located on the left side In the clinical manifestations, all patients present the tumor located in the mandibular angle, in front of the sternocleidomastoid muscle, describing a gradual and permanent growth in 72 subjects (62.6%), headache in 45 (39.1%), presence of heartbeat in 30 subjects (26.1%), dysphagia in 9 (7.9%), dizziness in 16 (13.9%) and dysphonia in 6 (5.2%). Among the most obvious signs of CBT, the Fontaine sign is described in 114 subjects (99.2%), adenomegaly in 20 (17.4%) and other less frequent signs such as murmur, parapharyngeal bulging and cranial nerve involvement. All patients were classified in both systems (Shamblin and ours called from the Andes). 39 patients (33.2%) with postoperative complications were described, grade I: 1 patient without complications; Grade II: of 58 subjects, 4 (3.5%) had temporary hypoglossal paralysis; in Grade III: of the 41 subjects, 24 (20.8%) presented external carotid artery ligation, hypoglossal and glossopharyngeal paralysis, recurrent lesion and superior larynx. In group IV, of the 15 operated subjects, 11 presented complications (9.6% of the total and 73% of the group), among which are external carotid artery ligation, hypoglossal injury and one patient with stroke and hemiparesis. A reoperation (0.86%) and no mortality are described. CONCLUSION: propose a preoperative classification that has the possibility of being associated with complications and prognosis.

Value of Head and Neck CT Angiography in the Clinical Evaluation of Intraoperative Bleeding Volume of Carotid Body Tumours / 中国医学科学院学报

To investigate the value of head and neck CT angiography(CTA)in the evaluation of intraoperative hemorrhage of carotid body tumours. Head and neck CTA images of 36 patients with carotid body tumours confirmed by pathology were retrospectively analyzed.Patients were divided into two groups based on the intraoperative bleeding volume:<500 ml and≥500 ml groups.The patient's age,sex,Shamblin classification,size of the lesion,number of blood supply arteries,course of the disease,plain scan,and enhanced CT value between two groups were compared and analyzed.Logistics regression equation was established based on the CTA parameters with significant differences between the two intraoperative bleeding volume groups,and combined parameter was acquired.The receiver operating characteristic curve was established based on CTA single and combined parameters. The bleeding volume during the operation of carotid body tumors was significantly correlated with the age of patients(=0.019),the maximum diameter of tumours on axial images(=0.003),the maximum upper and lower diameters(=0.004),Shamblin classification(=0.012),and number of blood supply arteries(<0.001).The area under the receiver operating characteristic curve of the number of feeding arteries,the maximum diameter of axial images,maximum upper and lower diameters,Shamblin classification,and combined parameters were 0.865,0.781,0.806,0.766,and 0.927,respectively.When the optimal critical value was 0.408,the Youden index was 0.794,and the corresponding accuracy,sensitivity,and specificity were 0.919,0.909,and 0.923,respectively. Preoperative head and neck CTA can be used to evaluate the intraoperative blood loss.Combined parameters has the best diagnostic performance compared with single parameters.

Mechanism of endothelin-1 mediated the cyclic intermittent hypoxia on carotid body plasticity in rats / 解剖学报

Objective To investigate the potential molecular mechanism of endothelin-1 (ET-1) involved in cyclic intermittent hypoxia (CIH) induced carotid body chemoreceptor plasticity. Methods (1) Animal experiment: 32 male Sprague-Dawley (SD) rats were randomly divided into two groups: Control group (Con) and CIH group (CIH), 16 rats per group. After 21 days of CIH exposure, each group (Con and CIH) was subdivided into 2 groups: Lail vein injection of ET-1 (1 x 10~6 mol/kg body weight) or same volume of saline according to the above dose. After 30 minutes of injection, carotid bodies were collected and Western blotting was used to detect the change of tested proteins. (2) Carotid body organ culture: Rat carotid bodies were isolated and cultured in the incubator, and treated with ET-i (lxlO"4 mol/L) for different times (0 minute, 10 minutes, 60 minutes). The effect of ET-1 on the phosphorylation of p38 mitogen-activated protein l kinase (p38 MAPK) was detected by Western blotting. Results (1) CIH increased the protein level of endothelin receptor A (ET-A)and ET-B in the rat carotid body. (2) Compared with the ET-1 injected Con group, phosphorylated protein kinase A (p-PKA), p-p38 MAPK, phosphorylated Ca2;/calmodulin-dependent protein kinase D (p-CaMK II) and phosphorylated cAMP response element-binding protein (p-CREB) and RhoA protein level were significantly up-regulated in ET-1 injected CIH rats. (3) Application of ET-1 to organ cultured carotid bodies resulted in the elevation of p-p38 MAPK in a time-dependent manner. Conclusion ET-1 may regulate CIH-induced carotid body chemoreflex plasticity through PKA/p38 MAPK/CaMK II/CREIJ and IthoA signaling.

Cirurgia híbrida na exérese de tumor glômico Shamblin II / Hybrid surgery in excision of a Shamblin II glomus tumor

O tumor glômico é uma neoplasia benigna rara originada de células paraganglionares da crista neural que se desenvolve na camada adventícia do vaso. São tumores não encapsulados e altamente vascularizados. Paciente feminina, 64 anos, foi diagnosticada com tumor glômico hipervascularizado com 5 cm posteriormente à bifurcação carotídea esquerda e oclusão de carótida contralateral. Optou-se por realizar embolização através de acesso endovascular seguida de punção percutânea direta, guiada por angiografia, para preenchimento da área remanescente. Após embolização, realizou-se a exérese cirúrgica do tumor com menor sangramento e maior facilidade para encontrar o plano de clivagem das estruturas adjacentes. Em acompanhamento tardio, a paciente apresenta-se sem recidiva tumoral. O tumor foi classificado como pertencente ao grupo Shamblin II, o qual inclui tumores apresentando de 4 a 6 cm com inserção arterial moderada. Através dessa dupla abordagem, foi possível notar uma redução relativa do sangramento intraoperatório e facilitação de identificação do plano de clivagem, colaborando para sua exérese e evitando o pinçamento cirúrgico

Glomus tumors are rare benign neoplasms originating from paraganglionic cells of the neural crest developing in the adventitious layer of the vessel. They are nonencapsulated and highly vascularized. A 64-year-old female patient was identified with a hypervascularized glomus tumor measuring 5 cm, posterior to the left carotid bifurcation and contralateral carotid occlusion. We performed preoperative embolization via endovascular access followed by direct percutaneous puncture, guided by angiography, to fill the remaining area. After embolization, surgical excision of the tumor was performed with reduced bleeding and it was easier to find the cleavage planes to adjacent structures. At late follow-up, the patient is free from tumor recurrence. The tumor was classified as Shamblin II, measuring 4 to 6 cm with moderate arterial insertion. Through this double approach we observed a relative reduction in intraoperative bleeding and improved identification of the cleavage plane, facilitating excision and avoiding surgical clamping

A Retrospective Analysis of Patients Presenting with Head and Neck Paragangliomas at Two Tertiary Referral Centres in Jamaica / Análisis retrospectivo de pacientes que presentan paragangliomas de cabeza y cuello en dos centros de remisión terciarios en Jamaica

ABSTRACT Objective: Paragangliomas are slow-growing tumours that present with varied clinical spectra. Early recognition is paramount in achieving reduced morbidity and mortality. There is a paucity of data regarding head and neck paragangliomas (HNPGs) in the Caribbean literature. This study aimed to reflect the clinical experience in the management of HNPGs at two Jamaican tertiary referral centres: the Kingston Public Hospital (KPH) and the University Hospital of the West Indies (UHWI). Methods: A retrospective analysis was conducted on all patients presenting to the Ear, Nose and Throat (ENT) departments of the UHWI in 2004-14 and of the KPH in 2012-14 with the diagnosis of a HNPG. Results: There were 15 patients, 1 male and 14 females. The average age at presentation was 47.1 years. The HNPGs in this series included eight patients with glomus tympanicum (GT, 53%), four with glomus jugulare (GJ, 27%), two with carotid body tumours (CBTs, 13%) and one with glomus vagale (GV, 7%). Eight patients underwent surgical resection (two CBTs, four GT and two GJ). Treatment outcomes achieved included: complete resection (four patients), stable with residual disease (two patients), and recurrence (two patients). Seven patients were awaiting definitive treatment, one patient with GJ was referred overseas, and one patient with GV defaulted. Conclusion: Glomus tympanicum is the most common HNPG in this series which contrasts with that of most international series. Despite the limitations within this region, such as limited access to angio-embolization and stereotactic modalities, the management outcomes are similar in some respects to the reported international literature.

RESUMEN Objetivo: Los paragangliomas son tumores de crecimiento lento que se presentan con variados espectros clínicos. Su detección precoz es fundamental para lograr una reducción de la morbilidad y la mortalidad. Hay escasez de datos con respecto a los paragangliomas de cabeza y cuello (PgCC) en la literatura del Caribe. Este estudio tuvo como objetivo reflejar la experiencia clínica en el tratamiento de PgCC en dos centros de remisión terciarios de Jamaica: jamaiquinos: el Hospital Público de Kingston (KPH) y el Hospital Universitario de UWI (HUWI). Métodos: Se llevó a cabo un análisis retrospectivo de todos los pacientes diagnosticados con PgCC que acudieron a los Departamentos de Otorrinolaringología de HUWI en 2004-14 y de KPH en 2012-14. Resultados: Hubo 15 pacientes - 1 varón y 14 hembras. La edad promedio al momento de presentarse fue 47.1 años. El PgCC en esta serie incluyó a ocho pacientes con glomus timpánico (GT, 53%), cuatro con glomus yugular (GY, 27%), dos con tumores del cuerpo carotídeo (TCC, 13%), y uno con glomus vagal (GV, 7%). Ocho pacientes fueron sometidos a resección quirúrgica (dos TCC, cuatro GT, y dos GY). Los resultados logrados con el tratamiento incluyeron: resección total (cuatro pacientes), estables con enfermedad residual (dos pacientes), y recurrencia (dos pacientes). Siete pacientes esperaban un tratamiento definitivo, un paciente con GY fue remitido al extranjero, y un paciente con GV no se presentó. Conclusión: El glomus timpánico es el PgCC más común en esta serie que contrasta con el de la mayoría de las series internacionales. A pesar de las limitaciones dentro de esta región, tales como el acceso limitado a la angioembolización y las modalidades estereotácticas, los resultados del manejo de la enfermedad son similares en algunos aspectos a la literatura internacional reportada.

Experience for surgical treatment and analyzing complication of carotid body tumor / 国际外科学杂志

Objective To analyze and summarize the experience of surgical treatment of carotid body tumor and prevention of relevant complications.Methods The clinical data of 45 cases of carotid body tumor diagnosed and treated by Department of Vascular Surgery,People's Hospital of Xinjiang Uygur Autonomous Region from August 1996 to June 2016 were retrospectively analyzed.All the patients were followed up for 18 months and were followed up in Department of Vascular Surgery,People's Hospital of Xinjiang Uygur Autonomous Region inpatient or outpatient review form,the main observation during follow-up of patients with postoperative complications and recovery.Carotid compression test (Matas test) will be performed 2 weeks preoperation.There were 20 males (4 carotid body lesions located on both sides,16 carotid body lesions on the unilateral side) and 25 females (1 carotid body lesion located on both sides of the neck,neck arteriomatous lesions in unilateral patients were 24 cases),duration of 0.5 to 6.0 years,the average duration of 3 years,analysis of postoperative complications.Results All the operations were successful.There were no perioperative deaths.Among the 45 patients undergoing surgical treatment,one or more surgical procedures were used.Thirty patients were followed up and the remaining 15 patients were lost to follow-up.During an average follow-up of 18 months,complications included 1 stroke,8 hypoglossal nerve injury,13 vagal injury ard 9 homer syndrome.No recurrence of patients was followed up within 6 months,the basic symptoms of nerve injury,1 case of vagus nerve and the tumor was followed up for 6 months,there was still difficulty swallowing and hoarseness.Five cases of bilateral lesions,including 3 cases underwent bilateral staging surgery,the operation was successful.One case of unilateral excision after vagal injury,it did not contralateral surgery;one case of one-sided surgery after the lost,the contralateral did not receive surgery.Conclusions Hoarseness after operation is not caused by recurrent laryngeal nerve injury,and it was recommended that bilateran lesions with smaller one should removed firstly.Matas test could not be regarded as criterion of intraoperative ligation during the operation.

The research progress of carotid web and cryptogenic stroke / 中华神经科杂志

Carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery just beyond the bifurcation.In recent years,it has been found that the carotid web is one of possible risk factors for cryptogenic stroke.Understanding the pathogenesis and pathological characteristics of carotid artery web,and accurately diagnosing the carotid artery web will help to implement targeted intervention for cryptogenic stroke,and reduce the recurrence of stroke events.In this paper,we will review the research progress of relationship between the carotid artery web and cryptogenic stroke,the common imaging features,pathological research,pathogenesis,diagnosis and treatment.

Nursing of seven cases of carotid body tumors treated by hybrid operation / 中华护理杂志

This article summarized nursing experience of 7 cases of carotid body tumors treated by hybrid operation.Key points of nursing included:preoperative carotid compression training,postoperative blood pressure management,head and neck immobilization together with lower extremity immobilization,and prevention and nursing of complications.All patients were recovered and discharged.

Paraganglioma del cuerpo carotídeo: reporte de caso / Carotidbody tumor: case report

Los tumores de cuerpo carotídeo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originados en los quimiorreceptores del cuerpo carotídeo. Se presenta el caso clínico de un tumor de glomuscarotídeo, en una mujer de 63 años que debutó con un aumento de volumen cervical derecho. El estudio con tomografía computarizada en fase angiográfica (Angio TC) demostró un tumor heterogéneo a nivel de la bifurcación carotídea que provocaba efecto de masa desplazando, pero sin infiltración en vasos carotídeos. Posteriormente, se realizó la extirpación completa del tumor con disección subadventicial. El informe histopatológico concluyó tumor de glomuscarotídeo con áreas de necrosis y pleomorfismo celular.

Carotid body tumors (paraganglioma) are highly vascular neoplasms, which are rare but usually benign. They are originated in the chemoreceptors of the carotid body. We present the clinical case of a carotid glomus tumor in a 63 year old woman who debuted with an increase in right cervical volume. The conducted studywith computed tomography at angiographic phase (Angio CT) demonstrated a heterogeneous tumor at the level of carotid bifurcation that caused a displacing mass effect but not infiltrating the carotid vessels. Complete excision of the tumor was performed with subadventitial dissection. The histopathological report concluded a carotid glomus tumor with necrosis areas and cell pleomorphism.

Paraganglioma de cuerpo carotideo / Carotid body paraganglioma

Contexto: Los paragangliomas del cuerpo carotideo son tumores adrenales de mayor frecuencia entre los paragangliomas; en términos generales, son infrecuentes y deben ser diagnosticados por técnicas de imagen para caracterizar la anatomía y grado de invasión del tumor, a fin de su planificación quirúrgica. Objetivo: evaluar la experiencia institucional del Hospital Carlos Andrade Marín en el manejo de los tumores del cuerpo carotideo. Sujetos y métodos: el estudio retrospectivo analizó los registros médicos de 26 pacientes con paragangliomas del cuerpo carotideo tratados en el Hospital Carlos Andrade Marín de Quito, en un periodo de 21 meses; se complementa con una revisión de la bibliografía. Resultados: del total del universo estudiado el paragaglioma se presentó en 20 mujeres que corresponde al 76%, y en 6 hombres que corresponde al 23. El tamaño promedio del tumor en los pacientes fue de 3,7 ± 1,4 cm. Según la clasificación de Shamblin el paraganglioma en el 74% de los pacientes se encontraba en clasificación ll, el 22% se encontraban en clasificación l, mientras que el 37% se encontraban en clasificación lll. El promedio de sangrado en los pacientes fue 331 ± 284 ml .El tiempo quirúrgico fue de 112 ± 37 minutos. La resección completa del tumor se realizó en el 100 % de los pacientes, en donde en el 7,4% hubieron complicaciones de lesion del nervio craneal y otras complicaciones ocurrieron en el 7,4 % de los pacientes. Conclusión: la experiencia del equipo quirúrgico del Hospital Carlos Andrade Marín ofreció una alternativa segura, con resultados satisfactorios y baja incidencia de secuelas a largo plazo. (AU)

Context: The paragangliomas of the carotid body are adrenal tumors of greater frequency among the paragangliomas; In general terms, they are infrequent and must be diagnosed by imaging techniques to characterize the anatomy and degree of tumor invasion, in order to plan their surgery. Objective: To evaluate the institutional experience of the Hospital Carlos Andrade Marin in the managemen of tumors of the carotid body. Subjects and methods: The retrospective study analyzed the medical records of 26 patients with paragangliomaof the carotid body treated in the Carlos Andrade Marín Hospital in Quito, in a period of 21 months; It icomplemented by a review of the bibliography. Results: of the total universe studied, paragaglioma was present in 20 women, corresponding to 76%, and in 6 men, corresponding to 23%. The average tumor size in the patients was 3.7 ± 1.4 cm. According to the classification of Shamblin paraganglioma in 74% of patients were in classification II, 22% were in classification I, while 37% were in classification III. The average bleeding in the patients was 331 ± 284 ml. The surgical time was 112 ± 37 minutes. Complete resection of the tumor was performed in 100% of the patients, where in 7.4% there were cranial nerve lesions and other complications occurred in 7.4% of the patients. Conclusions: The experience of the surgical team of the Hospital Carlos Andrade Marín offers a safe alternative, with satisfactory results and low incidence of long-term sequelae. (AU)