Clin Exp Otorhinolaryngol.  2010 Jun;3(2):91-95. 10.3342/ceo.2010.3.2.91.

Surgical Treatment of Carotid Body Paragangliomas: Outcomes and Complications According to the Shamblin Classification

• Lim JY
• Kim J
• Kim SH
• Lee S
• Lim YC
• Kim JW
• Choi EC

• KMID: 1460595
• DOI: http://doi.org/10.3342/ceo.2010.3.2.91

Abstract

OBJECTIVES
The objective of this study was to review our experience in the surgical management of carotid body paragangliomas and evaluate the outcomes and complications according to the Shamblin classification.
METHODS
Thirteen patients who had been diagnosed and surgically treated for carotid body tumors (CBTs) were enrolled in this study. We reviewed patient demographics, radiographic findings, and surgical outcomes collected from medical records.
RESULTS
Fifteen CBTs were found in 13 patients and 13 tumors were resected. Selective preoperative tumor embolization was performed on six patients. The median blood loss, operation time, and hospital stay for these patients were not significantly reduced compared to those without embolization. The median tumor size was 2.3 cm in Shamblin I and II and 4 cm in Shamblin III. The median intraoperative blood loss was 280 mL and 700 mL, respectively (P<0.05). Internal carotid artery ligation with reconstruction was accomplished on three patients (23%), and they all belonged to Shamblin III (38%). One Shamblin III patient (8%) developed transient cerebral ischemia, and postoperative stroke with death occurred in another Shamblin III patient. Postoperative permanent cranial nerve deficit occurred in three patients (23%) who were all in Shamblin III (P=0.03). There were no recurrences or delayed complications at the median follow up of 29 months.
CONCLUSION
Shamblin III had a high risk of postoperative neurovascular complications. Therefore, early detection and prompt surgical resection of CBTs will decrease surgical morbidity.

Keyword

Carotid body tumor; Paraganglioma

MeSH Terms

Carotid Artery, Internal
Carotid Body
Carotid Body Tumor
Cranial Nerves
Demography
Follow-Up Studies
Humans
Ischemic Attack, Transient
Length of Stay
Ligation
Medical Records
Paraganglioma
Recurrence
Stroke

Figure

• 

  Fig. 1 A 35-yr-old woman with a characteristic carotid body paraganglioma. (A) Axial contrast-enhanced CT shows an avidly enhancing mass splaying the external carotid artery (ECA) and internal carotid artery (ICA) at the left carotid bifurcation. (B) Axial T1- weighted images show a mass with prominent vascular flow voids. (C) Angiography shows intense tumor blush between the ICA and ECA.

Reference

1. Persky MS, Setton A, Niimi Y, Hartman J, Frank D, Berenstein A. Combined endovascular and surgical treatment of head and neck paragangliomas: a team approach. Head Neck. 2002; 5. 24(5):423–431. PMID: 12001071.

2. Muhm M, Polterauer P, Gstottner W, Temmel A, Richling B, Undt G, et al. Diagnostic and therapeutic approaches to carotid body tumors: review of 24 patients. Arch Surg. 1997; 3. 132(3):279–284. PMID: 9125028.

3. Gordon-Taylor G. On carotid tumours. Br J Surg. 1940; 10. 28(110):163–172.

4. van der Bogt KE, Vrancken Peeters MP, van Baalen JM, Hamming JF. Resection of carotid body tumors: results of an evolving surgical technique. Ann Surg. 2008; 5. 247(5):877–884. PMID: 18438127.

5. Hallett JW Jr, Nora JD, Hollier LH, Cherry KJ Jr, Pairolero PC. Trends in neurovascular complications of surgical management for carotid body and cervical paragangliomas: a fifty-yr experience with 153 tumors. J Vasc Surg. 1988; 2. 7(2):284–291. PMID: 2828696.

6. Westerband A, Hunter GC, Cintora I, Coulthard SW, Hinni ML, Gentile AT, et al. Current trends in the detection and management of carotid body tumors. J Vasc Surg. 1998; 7. 28(1):84–92. PMID: 9685134.

7. Shamblin WR, ReMine WH, Sheps SG, Harrison EG Jr. Carotid body tumor (chemodectoma): clinicopathologic analysis of ninety cases. Am J Surg. 1971; 12. 122(6):732–739. PMID: 5127724.

8. Makeieff M, Raingeard I, Alric P, Bonafe A, Guerrier B, Marty-Ane C. Surgical management of carotid body tumors. Ann Surg Oncol. 2008; 8. 15(8):2180–2186. PMID: 18512105.

9. Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, Herrera-Gomez A. Does Shamblin's classification predict postoperative morbidity in carotid body tumors? A proposal to modify Shamblin's classification. Eur Arch Otorhinolaryngol. 2006; 2. 263(2):171–175. PMID: 16010570.

10. Carroll W, Stenson K, Stringer S. Malignant carotid body tumor. Head Neck. 2004; 3. 26(3):301–306. PMID: 14999807.

11. Wang SJ, Wang MB, Barauskas TM, Calcaterra TC. Surgical management of carotid body tumors. Otolaryngol Head Neck Surg. 2000; 9. 123(3):202–206. PMID: 10964291.

12. Sajid MS, Hamilton G, Baker DM. A multicenter review of carotid body tumour management. Eur J Vasc Endovasc Surg. 2007; 8. 34(2):127–130. PMID: 17400487.

13. Neves F, Huwart L, Jourdan G, Reizine D, Herman P, Vicaut E, et al. Head and neck paragangliomas: value of contrast-enhanced 3D MR angiography. AJNR Am J Neuroradiol. 2008; 5. 29(5):883–889. PMID: 18339724.

14. DuBois J, Kelly W, McMenamin P, Macbeth GA. Bilateral carotid body tumors managed with preoperative embolization: a case report and review. J Vasc Surg. 1987; 4. 5(4):648–650. PMID: 3560359.

15. Schick PM, Hieshima GB, White RA, Fiaschetti FL, Mehringer CM, Grinnell VS, et al. Arterial catheter embolization followed by surgery for large chemodectoma. Surgery. 1980; 4. 87(4):459–464. PMID: 6245477.

16. Kasper GC, Welling RE, Wladis AR, CaJacob DE, Grisham AD, Tomsick TA, et al. A multidisciplinary approach to carotid paragangliomas. Vasc Endovascular Surg. 2006-2007; Dec–Jan. 40(6):467–474. PMID: 17202093.

17. LaMuraglia GM, Fabian RL, Brewster DC, Pile-Spellman J, Darling RC, Cambria RP, et al. The current surgical management of carotid body paragangliomas. J Vasc Surg. 1992; 6. 15(6):1038–1044. PMID: 1597886.

18. Litle VR, Reilly LM, Ramos TK. Preoperative embolization of carotid body tumors: when is it appropriate? Ann Vasc Surg. 1996; 9. 10(5):464–468. PMID: 8905066.