Trends in neurovascular complications of surgical management for carotid body and cervical paraganglionmas: A fifty-year experience with 153 tumors John.

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Presentation transcript:

Trends in neurovascular complications of surgical management for carotid body and cervical paraganglionmas: A fifty-year experience with 153 tumors John W. Hallett, M.D., John D. Nora, M.D., Larry H. Hollier, M.D., Kenneth J. Cherry, M.D., Peter C. Pairolero, M.D. Journal of Vascular Surgery Volume 7, Issue 2, Pages 284-291 (February 1988) DOI: 10.1016/0741-5214(88)90147-4 Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 The classification of Shamblin et al. of the difficulty of surgical resection. Group I tumors are localized and easily resected. Group II includes tumors adherent or partially surrounding vessels. Group III paragangliomas intimately surround or encase the vessels. ICA = internal carotid artery; ECA = external carotid artery. Journal of Vascular Surgery 1988 7, 284-291DOI: (10.1016/0741-5214(88)90147-4) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Resection of smaller carotid body tumors. A, Proximal and distal control of the carotid artery is the first step in safe resection. B, The hypoglossal nerve should be dissected from the tumor surface. C, Bipolar cautery can control bleeding on the tumor surface while dissection with fine scissors continues in the periadventitial plane. Temporary carotid clamping allows for a safer and easier tumor dissection of the carotid bifurcation. D, Once the tumor is freed from the carotid bifurcation, the superior laryngeal nerve can be identified posteriorly. Tumor dissection can continue up along the internal carotid artery in the periadventitial plane. Journal of Vascular Surgery 1988 7, 284-291DOI: (10.1016/0741-5214(88)90147-4) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Dissection zones (see text). Most serious neurovascular injuries occur in zone III. Journal of Vascular Surgery 1988 7, 284-291DOI: (10.1016/0741-5214(88)90147-4) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Neck incision for large carotid body tumors. A nasotracheal tube allows greater displacement of the floor of the mouth during dissection or retraction beneath the mandible. Journal of Vascular Surgery 1988 7, 284-291DOI: (10.1016/0741-5214(88)90147-4) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Resection of large carotid body tumors. A, Large tumors generally surround the external and internal carotid arteries and encase some of the cranial nerves. B, Identification of the facial nerve, mobilization of the parotid galnd, and division of the stylohyoid muscles faciliate safer and superior exposure. C, After mobilization of the hypoglossal nerve, ligation of the external carotid artery and its branches decreases bleeding from the tumor and facilitates dissection away from the internal carotid artery. D, The tumor is dissected away from the internal carotid artery in the periadventitial plane. Journal of Vascular Surgery 1988 7, 284-291DOI: (10.1016/0741-5214(88)90147-4) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions