Update in the classification and the role of intra-arterial stenting in the management of carotid body paragangliomas

Head Neck. 2019 May;41(5):1379-1386. doi: 10.1002/hed.25567. Epub 2019 Feb 16.

Abstract

Background: To review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra-arterial stenting in their surgical management.

Methods: Retrospective case series of 20 patients with 28 CBPs that were surgically resected at our center. Intra-arterial stenting was performed in Shamblin II and II classes.

Results: The mean follow-up was 47.8 months. Five (17.9%) tumors were Shamblin class I, 15 (53.6%) were class II, and 8 (28.6%) were class III. Thirteen (68.4%) CBPs were associated with other paragangliomas. The internal carotid artery (ICA) was stented preoperatively in eight (28.6%) cases and occluded in four (14.3%) cases. The tumor extended to the jugular foramen in six cases (21.4%). Intraoperatively, there was an ICA injury in one case of Shamblin II CBP in the present era.

Conclusions: The proposed classification enables the clinician to plan the management of the ICA and the right approach. Stenting of the ICA gives a chance for complete tumor removal with arterial preservation.

Keywords: Shamblin classification; carotid body paragangliomas; internal carotid artery; intra-arterial stenting; surgical approaches.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Angioplasty / methods*
  • Anticoagulants / administration & dosage
  • Carotid Artery, Internal / pathology
  • Carotid Artery, Internal / surgery
  • Carotid Body Tumor / classification*
  • Carotid Body Tumor / diagnostic imaging
  • Carotid Body Tumor / surgery*
  • Computed Tomography Angiography / methods
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Humans
  • Imaging, Three-Dimensional
  • Italy
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Paraganglioma / classification*
  • Paraganglioma / diagnostic imaging
  • Paraganglioma / surgery*
  • Preoperative Care / methods
  • Retrospective Studies
  • Risk Assessment
  • Stents / statistics & numerical data*
  • Time Factors
  • Treatment Outcome

Substances

  • Anticoagulants