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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2009 September;16(3):127-32
Carotid body tumors: radioguided surgical approach
Martinelli O. 1, Irace L. 1, Massa R. 2, Gossetti B. 3, Faccenna F. 3, Laurito A. 3, Benedetti Valentini F. 3
1 Emergency Department, La Sapienza University, Umberto I Policlinic, Rome, Italy
2 Department of Nuclear Medicine, La Sapienza University Umberto I Policlinic, Rome, Italy
3 Department of Vascular Surgery, La Sapienza University, Umberto I Policlinic, Rome, Italy
Aim. Aim of this article was to define the role of color-coded imaging (CCI) and Indium In-111 pentetreotide scintigraphy-SPECT (In-111SRS-SPECT) for preoperative and intraoperative detection of carotid body tumor (CBT) site, nature and multicentricity, and for follow-up within a multidisciplinary treatment.
Methods. From January 1997 to June 2008, 12 patients suffering from 15 CBT (4 bilateral) and 1 vagus nerve neurinoma were submitted to CCI and In-111SRS-SPECT preoperatively and during follow-up. Intraoperative radiocaptation by Octreoscan was also carried out on all lesions.
Results. Preoperatively In-111SRS-SPECT detected all chemodectomas (sensitivity 100%) and no radioisotopic uptake was detected in vagus nerve neurinoma. CCI and In-111SRS-SPECT also provided data to group CBTs showing a good agreement with Shamblin classification: 5 in class I, 5 in class II and the remaining 5 in class III. Preoperative embolization was carried out for 7 larger tumors as evaluated by CCI and In-111SRS-SPECT. When CCI and radioisotopic scans demonstrated a very high tumor site above the angle of the mandible, a multidisciplinary treatment involving vascular and maxillofacial teams was planned. Intraoperatively Octreoscan demonstrated microscopic tumor leftovers promptly removed in 1 case and an unresectable remnant at base skull in 1. During follow-up CCI and radioisotopic scans showed no recurrence in all cases and a slightly enlargement of that intracranial residual detected during surgery.
Conclusion. Computed tomography (CT) and magnetic resonance (MR) imaging are reliable techniques for CBTs detection but do not provide any information concerning metastatic repetitions or multicentricity. An early and far less invasive localization of those tumors at neck can be achieved by ultrasounds. Radioisotopic scans seem to provide useful data for diagnosis of all types of paragangliomas and of malignant, recurrent or multicenter tumors; nuclear and ultrasound studies confirmed by CT or MR examination provide data for a multidisciplinary approach involving vascular, maxillofacial surgeons and radiologist. During surgery, radiolocalization is helpful in detecting tumor leftovers, which would entail a recurrence and allows a more radical radioguided excision. ECD and In-111SRS-SPECT may reliably be used for follow-up minimizing the need of postoperative CT or MR controls.