THE CURRENT SURGICAL-MANAGEMENT OF CAROTID-BODY PARAGANGLIOMAS

被引:105
作者
LAMURAGLIA, GM
FABIAN, RL
BREWSTER, DC
PILESPELLMAN, J
DARLING, RC
CAMBRIA, RP
ABBOTT, WM
DREZNER, AD
ODONNELL, T
PILCHER, DB
DONOVAN, TJ
机构
[1] MASSACHUSETTS GEN HOSP, DIV VASC SURG, BOSTON, MA 02114 USA
[2] MASSACHUSETTS GEN HOSP, GEN SURG SERV, HEAD & NECK SERV, BOSTON, MA 02114 USA
[3] MASSACHUSETTS GEN HOSP, DEPT RADIOL, BOSTON, MA 02114 USA
[4] HARVARD UNIV, SCH MED, MASSACHUSETTS EYE & EAR INFIRM, BOSTON, MA 02115 USA
关键词
D O I
10.1016/0741-5214(92)90461-G
中图分类号
R61 [外科手术学];
学科分类号
摘要
To determine if recent trends in evaluation and therapy have contributed to the successful surgical management of carotid body paragangliomas, we reviewed our experience over the past decade. Nineteen carotid body paragangliomas were identified in 17 patients. Eleven patients underwent complete, preoperative embolization of their afferent arteries with one complication. Calculated carotid body paragangliomas surface areas did not differ between the embolized 64.6 +/- 43.3 cm2 and nonembolized 63.0 +/- 57.9 cm2 lesions. Intraoperative blood loss was lower (p = 0.02) in the patients treated with embolization (372 +/- 213 ml) compared with their cohorts (609 +/- 564 ml). However, the operative times were equivalent 4.1 hours versus 4.5 hours in both groups. Intraoperative electroencephalographic (EEG) monitoring was used in 10 patients; in one patient the EEG indicated intraoperative thrombosis of the carotid artery, which was successfully treated by thrombectomy without complications. Two patients required carotid bifurcation resection and vascular reconstruction to remove the entire tumor; a late stroke manifested by contralateral hand weakness developed in one of these patients. The incidence of cranial nerve injury was tow at 16%, with one transient ramus mandibularis paresis and two instances of vocal cord dysfunction. Two additional patients had a postoperative Horner's syndrome. We conclude that by diminishing intraoperative blood loss through complete and careful preoperative embolization and use of intraoperative EEG monitoring along with careful surgical technique, the complications associated with this challenging operation are facilitated and diminished.
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页码:1038 / 1045
页数:8
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