Carotid body paraganglioma: review and surgical management

The term paraganglia best defines the spread in the body of clusters of cells with histological and cytochemical characteristics of neuroendocrine cells originating from the neural crest. with either sympathetic or parasympathetic function. Carotid body hyperplasia is associated with long-standing hypoxia as in native inhabitants in high altitude or in patients with chronic pneumonopathies. while carotid body paraganglioma is a rare parasympathetic tumor with significant morbidity. Tumor extension per se, associated cranial nerve involvement, and the estimated 3-10% malignant potential. particularly at a young: age, make early diagnosis and treatment of carotid body paraganglioma mandatory. Biopsy should be avoided, because of the accompanying incidence of hemorrhage, while it is essential in all cases to investigate both sides of the neck to exclude bilateral tumors. The modalities of therapy include preoperative embolization, preoperative and postoperative radiation with ambiguous results of both, and complete surgical removal which constitutes the definite therapy. The current stroke rate is less than 5%. The histological appearance of a carotid body paraganglioma is not a reliable guide to its propensity for malignant behavior and recurrences are most likely to appear in patients who have multiple paragangliomas or a family history of carotid body paraganglioma

Comparative results of staged and simultaneous bilateral carotid endarterectomy: a clinical study and surgical treatment

Objective: Bilateral carotid stenoses are actually managed by staged endarterectomy, The present study compares the results of the above surgical procedure with simultaneous bilateral carotid endarterectomy. Methods: Sixty-four carotid endarterectomies were carried out on two groups of thirty-two patients with bilateral carotid stenoses, Fifteen patients (group A) were subjected to staged and 17 patients (group B) who were subjected to simultaneous bilateral carotid endarterectomies, Results: The mortality rate was zero in both groups; no statistically significant difference was found concerning complications related to the heart, neurological deficit and postoperative hypertension. Conclusions: Simultaneous carotid endarterectomy is a challenging and technically demanding operation but with limited indications in strictly selected patients. The development of methods of more effective monitoring and protection of the cerebral cells might broaden the indications of such a surgical tactic in the future. Staged carotid endarterectomy, however, remains the method of choice for the management of bilateral carotid occlusive disease. (C) 2000 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved