The Role of Internal Carotid Artery Stent in the Management of Skull Base Paragangliomas

Simple Summary In lateral skull base surgery, one of the greatest challenges remains the internal carotid artery. Paragangliomas can encase and finally invade the intrapetrosal carotid artery, making preservation of the vessel and of sufficient cerebral blood supply challenging. The use of intracranial endovascular stents makes the preoperative reinforcement of the arterial wall feasible, allowing the surgeon to deliberately manipulate the vessel and perform a safe tumor dissection from the stented artery without sacrificing it. It represents a valid alternative to more aggressive preoperative vascular treatments worth considering in cases of extensive vascular encasement of the internal carotid artery to increase surgical safety and radicality.Abstract Background: After two decades from its introduction in the lateral skull base paraganglioma surgery, the indications and results of preoperative internal carotid artery stenting should be critically assessed. Materials and Methods: Monocentric retrospective study on 26 patients affected by head and neck paragangliomas (19 tympanojugular paragangliomas, 4 carotid body paragangliomas, 3 vagal paragangliomas) preoperatively treated with internal carotid artery stents between 2008 and 2023. The preoperative findings, the intraoperative complications and the final surgical results were analyzed. Results: The stent complication rate was less than 3.1%. Self-expanding highly flexible intracranial nitinol stents were applied. In all cases, it was possible to completely mobilize the internal carotid artery and perform a vascular dissection of the tumor. Gross total tumor resection was possible in 85% of cases. The median follow up was 7.83 y (SD +/- 3.93 y). No local recurrence was observed. Conclusions: The preoperative vascular stent facilitates tumor dissection from the internal carotid artery without risk of vascular damage, helping the surgeon to achieve surgical radicality. The vascular stent is indicated in the case of revision surgeries, circumferential involvement of the vessel and in cases with non-insufficient intracerebral crossflow. Procedural complications, temporary antiplatelet therapy and delay of surgery are the limitations of the procedure.