Management of the carotid artery in paraganglioma surgery
| Autor: | Vivienne J. Halpern, Jon R. Cohen |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Carotid arteries Dissection (medical) Sensitivity and Specificity Paraganglioma Suture (anatomy) Monitoring Intraoperative medicine.artery Humans Medicine Intraoperative Complications Ligation business.industry Mortality rate Cranial nerves General Medicine medicine.disease Surgery Carotid Arteries medicine.anatomical_structure Otorhinolaryngology Head and Neck Neoplasms Female Radiology Internal carotid artery business Artery |
| Zdroj: | Otolaryngologic Clinics of North America. 34:983-991 |
| ISSN: | 0030-6665 |
| DOI: | 10.1016/s0030-6665(05)70358-3 |
| Popis: | Complete resection of cervical paragangliomas can be difficult secondary to the size, tumor vascularity, and the adherence to local vascular structures and the lower cranial nerves. The size and involvement of the tumor determine the management of the carotid artery. Anand et a12 reviewed 1181 published cases of carotid body tumors treated with surgical resection. Internal carotid artery injury was identified in 275 cases (23.2%). Of these, most occurred during dissection of tumors markedly adherent to the artery wall. Sixty-two cases (22.5%) were repaired with simple suture or patch repair, with an overall occurrence of CNS complications of 26.5%. For those that required only simple suture (62 cases), the CNS complication rate was 3.2%. In 89 cases (32.3%), the internal carotid artery was ligated with an associated stroke rate of 66% and a 46% mortality rate. In 125 cases (45%), the internal carotid artery was reconstructed, with a 9.7% stroke rate and a 2.4% mortality rate. The most important factors in managing the carotid artery are adequate preoperative assessment and preparation during surgery for any possibility. Injuries to the internal carotid artery lead to significant intraoperative hemorrhaging with resultant transfusions and cerebrovascular complications in as many as 50% of patients. A multidisciplinary team approach is often helpful in the management of these types of potential complications. The preoperative assessment should include evaluation of the size of the tumor; its uppermost extension; and its relationship to the common, internal, and external carotid arteries.2, Multiple modalities now allow for |
| Databáze: | OpenAIRE |
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