PARAGANGLIOMAS OF THE CAROTID BIFURCATION - ONCOLOGICAL ASPECTS OF VASCULAR-SURGERY

The present study reviews in concise form the past 12 years of our cli nical experience with paragangliomas of the carotid body, Every aspect of the anatomical, histological and biological behaviour of paragangl iomas of the carotid body has been recorded in order to be able to def ine better surgical management and the clinical prognosis. In addition to the conventional histological methods of investigation we also app lied immunohistochemistry and made use of electron microscopy. Eightee n tumours of the carotid body in 12 female and four male patients with a mean age of 54 years (34 to 70 years) were treated surgically, Angi ography of the aortic arch and the supra-aortic branches was undertake n diagnostically in every case, In three patients computer tomography and magnetic resonance imaging demonstrated spreading of the tumour up to the base of the skull and pre-operative embolization of the arteri es supplying the tumour was performed to decrease tumour vascularity, In four cases (22%) resection of the internal carotid artery and its r econstruction by a saphenous vein graft was required in order to achie ve the therapeutic aim of a complete extirpation of tumourous tissue a nd preserving the vascular system of the internal carotid artery, In t hree cases (16%) there was histological evidence of a metastasizing pr ocess to the local lymph nodes of the neck and, due to this criterion of malignancy, 50-60 Gy of radiation was applied to the site of the tu mour after surgery, Four patients experienced a transient neurological deficit in the supply area of the hypoglossal and the recurrent nerve s, In one case, the vagus nerve could not be retained. In an average f ollow-up of 102 months we recorded one case of local recurrence 13 mon ths after the initial resection and radiation treatment applied to a m alignant paraganglioma, All the other patients were doing well without evidence of recurrent disease.