DSA Diagnosis of Carotid Body Tumor

Objective: To make a further understanding of the DSA features of the carotid body tumor (CBT) and to explore the clinical value of DSA diagnosis and interventional treatment for CBT. Methods: Twelve cases of CBT with DSA data were analyzed retrospectively. The DSA appearances in all of the patients were observed dynamically in a double blind manner by two experienced radiologists together and a consensus interpretation formed. Results: DSA could establish definitive diagnosis in all cases. The DSA features of the CBT were: the increase of bifurcation angles of internal and external carotid arteries in all cases; the CBT supplied by external carotid arteries in most cases and the significant increase of tumor vessels in bifurcation; invasion of internal or external carotid arteries in 6 cases. The tumor staining disappeared mostly after the supplying arteris were embolized in 2 cases, and the bleeding during the operation reduced significantly. Conclusion: The DSA is useful in the diagnosis of the CBT and for therapeutic planning. The pre-operation embolization of the CBT contributes to reduce the bleeding during operation.

Efficacy of Surgical Therapy for Carotid Body Tumors

Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. Results Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. Conclusion It is essential to make a proper surgical strategy, which can reduce postoperative com- plications.

ANALYSIS OF EFFECT AND COMPLICATION ON SURGICAL TREATMENT OF CAROTID BODY TUMORS IN 46 CASES

Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT which were surgically treated with different kind of procedures.Resul t.All procedures performed successfully except that the CBT was not excised in 4cases.No operative mortality was observed.There were2postoperative hemiple gia,4hypoglossal nerve impairment ,2glossopharyngeal nerve impairment ,1va gus nerve impairment ,and1accessory nerve impairment.One patient presented p ostoperative cranial nerve impairment in glossopharyngeal,vagus and hypoglossa l nerves.Two patients developed local recurrence during the long-term follow-up.Conclusion.Complete surgical excision was possible in each patient if th e diagnosis had been cor-rectly made through selective preoperative angiography ,vessel ultrasound Doppler and other examinations.Reasonable surgical procedur e and Matas training were necessary to the successful surgical treatment and t hus decrease the complicative incidence rate of carotid chemodectomas.

Large carotid body tumor successfully resected in hybrid operating theatre: A case report

BACKGROUND Surgical treatment for large carotid body tumor (CBT),particularly the Shamblin III type,is challenging and rarely reported.CASE SUMMARY In July 2014,a 63-year-old woman presented to our hospital with a large CBT (130 mm × 60 mm × 70 mm).The lesion was hypervascular,spanned from the first to the seventh cervical vertebra,and adhered to the right common carotid artery (CCA),internal carotid artery (ICA) and external carotid artery (ECA).The resection was carried out in a hybrid operating theatre.First,we used Onyx gel to embolize the feeding artery.An ICA balloon was used to prevent gel entry into the ICA.After shrinkage and hardening of the CBT,we quickly resected the CBT as well as a part of the ECA that adhered to the CBT.A vascular shunt was inserted between CCA and ICA,and the part where the ICA was cut off from the CCA was directly sutured.A follow-up at four years later showed no neurological damage.CONCLUSION For large hypervascular CBT,embolization of the feeding artery prior to resection is helpful.The hybrid operating theatre is the ideal platform to carry out such operations.

Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report

BACKGROUND Carotid body tumor(CBT)is a chemoreceptor tumor located in the carotid body,accounting for approximately 0.22%of head and neck tumors.Surgery is the main treatment method for the disease.CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome(OSAHS)and hypoxia after surgical resection of bilateral CBTs.This patient was admitted,and relevant laboratory and imaging examinations,and polysomnography(PSG)were performed.After the definitive diagnosis,continuous positive airway pressure(CPAP)treatment was given,which achieved good efficacy.CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs,and diagnosis by PSG and CPAP treatment are helpful for this patient.

Diagnosis of carotid body tumor by digital subtraction angiography

Objective: To make a further understanding of the features of the carotid body tumor (CBT) by digital subtraction angiography (DSA) so as to explore the clinical value of DSA diagnosis and interventional therapy for CBT. Methods: DSA data from 12 cases of CBT were analyzed retrospectively. A consensus interpretation of the DSA appearances in all of the patients was reached after dynamic observation by 2 experienced radiologists in a double blind manner. Results: Definite diagnosis in all cases could be made by DSA. The DSA features of the CBT included bigger bifurcation angles of the internal and external carotid arteries, displacement of internal and external carotid arteries, CBT supplied by external carotid arteries in most cases and the significant increase of tumor blood vessels in bifurcation. Invasion of internal or external carotid arteries was found in 6 cases. Smaller stained area of the tumor and significantly reduced intraoperative bleeding were found after embolization of the supplying arteria in 2 cases. Conclusion: DSA is the effective method for the diagnosis and preoperative assessment of CBT. Preoperative embolization of CBT may contribute to the reduced intraoperative bleeding.

Eight cases of carotid body tumor diagnosed by Bmode ultrasonic imaging

This paper reports that 8 patients with carotid body tumors were diag-nosed by B-mode ultrasonic imaging.Among them,only 3 were originally clinicallydiagnosed as having the disease.The features of carotid body tumors in the 8cases,seen by B-mode ultrasonogram,are described.It is considered thatultrasonography of carotid body tumors is specific,trauma-free,accurate andsimple,and it may be an important method in identifying and diagnosing the dis-ease.

Recurrent malignant carotid body tumor:report of one case and review of the literature

Carotid body tumor （CBT） is a rare tumor, which is composed of chromaffin cells, groupsof cells associated with the autonomous system, occurring at the carotid bifurcation. This tumor grows slowly, usually with a history of several years and seldom undergoes malignant transformation. The majority of CBT are benign, only few cases of malignant CBTs were reported in the literature. 1.3 Overa period of 10 years （1993-2004）, 28 patients with CBT were diagnosed and surgically treated in the Department of Oral and Maxillofacial Surgery,

Significance of the preoperative guidance of dual-source CT in carotid body tumor

Background Accurate views of the head and neck vessels, tumor angiogenesis and the relationship of tumor and the surrounding blood vessels are especially crucial to carotid body tumor （CBT） patients. The aim of this study was to explore the value of dual-source CT （DSCT） cerebral and carotid angiography in CBT diagnosis.Methods DSCT cerebral and carotid angiography was performed on nine patients with CBT. Two-dimensional and three-dimensional reconstruction images were obtained by means of multiple planar reconstructions （MPR）,maximum intensity projection （MIP） and volume rendering （VR）. All patients were subjected to color Doppler flow imaging （CDFI） examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery.Results DSCT angiography was successful in all patients. CBTs were diagnosed in 9 patients with 10 lesions （1 case had multiple bilateral CBTs）. The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients had clearly demonstrated head and neck vessels, tumor angiogenesis, and tumor relationship with the surrounding blood vessels. The internal and external carotid artery （ICA, ECA） were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases （4 tumors） showed arterial phase homogeneous enhancement; 5 cases （6 tumors） had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the nearby blood vessels and tumor structure, instead of tumor angiogenesis. However, DSCT can display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings.Conclusions DSCT cerebral and carotid angiography can provide reliable information for the operation. It might be a valuable CBT diagnostic method by showing accurate views of the CBT along with the bilateral neck and brain blood vessels.

多普勒超声对颈动脉体瘤患者分型及病理预测的应用价值

目的探究多普勒超声对颈动脉体瘤患者分型及病理预测的应用价值。方法回顾性选择2020年1月~2022年11月我院及外院经手术病理证实的70例颈动脉体瘤患者,共74个瘤体影响资料,术前均接受过CT血管成像检查,其中39例43个瘤体术前有多普勒超声检查史。Pearson法分析术前CT血管成像与超声对患者瘤体最大径测值与术后病理测值关系,对比CT血管成像与超声对颈动脉体瘤与术中分型一致性。结果70例颈动脉体瘤患者中有56例检出肿块/无痛性肿块渐大,14例有临床症状。但ShamblinnⅡ型与ShamblinnⅢ型无症状或肿块渐大、临床症状比较无统计学意义(P>0.05)。39例35个组织完整颈动脉体瘤瘤体术前超声最大径测值1.92~7.83cm,CT血管成像为2.02~7.24cm,病理为2.02~8.03cm。,超声与CT血管成像瘤体最大径测值比较无统计意义(P>0.05),术前超声和CT血管成像瘤体最大径测值与手术病理测值呈正相关关系(r=0.854、0.746,P<0.001);70例66个组织完整瘤体CT血管成像测值与手术病理测值呈正相关关系(r=0.664,P<0.001)。39例35个组织完整颈动脉体瘤瘤体,手术病理证实ShamblinⅡ型21例,超声检出19例与其结果一致,CT血管成像检出18例与其结果一致;手术病理证实ShamblinⅢ型14例,超声和CT血管成像检出一致。结论多普勒超声对颈动脉体瘤患者分型及病理预测具有较好应用价值。

44例颈动脉体瘤的外科治疗

目的 总结颈动脉体瘤诊断、术前准备、手术治疗以及并发症防治的经验。方法 对采用肿瘤剥除术、同时切除颈外动脉术、与颈动脉分叉一并切除后血管重建术以及颈总动脉结扎术等手术方式治疗的 44例颈动脉体瘤进行回顾性分析。结果 本组病例手术切除率 90 9% ,无手术死亡。偏瘫 2例 ,舌下神经损伤 4例 ,舌咽神经损伤 2例 ,迷走神经损伤 1例 ,副神经损伤 1例 ,其中 1例同时有Ⅸ、Ⅹ、Ⅻ颅神经部分损伤。长期随访复发 2例。结论 术前选择性血管造影、血管超声多普勒等检查以明确诊断 ,合理的Matas训练以及选择适当的术式对于颈动脉体瘤治疗是必要的。

颈动脉体瘤的MRI和MRA表现

目的 探讨颈动脉体瘤的MRI及MRA表现。材料与方法 13例 15个颈动脉体瘤术前SET1WI及FSET2 WI检查 ,其中行 2DTOFMRA检查者 12个 ,SET1WI增强检查者 10个。结果 15个颈动脉体瘤均位于颈动脉分叉水平 ,13个骑跨于颈动脉分叉(86 .6 6 % )。T1WI表现为等或略高信号 ,T2 WI表现为混合高信号。SET1WI 13个肿块内可见流空信号 (86 .6 6 % ) ,FSET2 WI均可见流空信号 (10 0 % )。 14个颈动脉体瘤周边可见低信号包膜 (93 .33 % )。 12个行MRA检查者 9个表现为颈动脉分叉扩大 (75 % ) ,其中4个可见肿瘤血管 (33 .33 % ) ,10个增强检查均表现为明显强化。结论 颈动脉体瘤有特征性的MRI及MRA表现 ,MRI及MRA是颈动脉体瘤安全。

颈动脉体瘤治疗中保全颈动脉连续性的处理

目的颈动脉体瘤与颈动脉关系密切,如何处理颈动脉是手术成功与否的关键。文中总结了15例颈动脉体瘤患者手术治疗中保全颈动脉连续性的经验。方法收集南京军区南京总医院口腔科2005年3月至2013年6月收治的颈动脉体瘤患者15例,17个瘤体,其中2例患者为双侧。17个瘤体中shamblinⅠ、Ⅱ型分别6个,Ⅲ型5个。15个瘤体行单纯剥离术,其中shamblinⅡ型3个、shamblinⅢ型2个颈动脉破损后单纯修补;其余2个shamblinⅢ型瘤体行瘤体＋颈外动脉切除,颈内动脉破损处单纯缝合修补。所有患者术前均未行颈动脉压迫及球囊阻断试验。结果 15例患者17个瘤体均成功切除。手术中均完整保全了颈总、颈内动脉连续性。术后出现迷走神经损伤所致的声音嘶哑、呛咳13例,随访2年呛咳症状均恢复,1例仍遗有轻度的声音嘶哑症状;舌下神经损伤4例,患者出现伸舌偏斜症状,随访6月后均恢复。随访1～9年,15例患者均无复发。结论绝大多数颈动脉体瘤只要手术中方法得当,是可以保证瘤体从动脉壁上完整剥离,从而保全颈动脉连续性,可放弃术前颈动脉压迫训练或球囊阻断试验。

颈动脉体瘤的灰阶超声诊断

目的：探讨灰阶超声对颈动脉体瘤的诊断价值。资料和方法：用灰阶超声对３６例共３７个手术和病理证实的颈动脉体瘤进行分析，肿瘤最大１０ｃｍ，最小２．５ｃｍ。结果：颈动脉体瘤在灰阶超声上主要表现为位于颈动脉分叉处有管道样结构或无回声区的低回声光团（８１％），颈内外动脉间距增大，多大于１０ｍｍ等。

超声对颈动脉体瘤的诊断价值

目的研究超声在颈动脉体瘤诊断中的价值。方法分析32个颈动脉体瘤病例系列的超声征象。结果本组29例颈动脉体瘤,单发26例(89.7%),双侧3例(10.3%),共32个肿瘤。所有病灶超声全部检出,超声检查提示颈动脉体瘤31个,提示神经鞘瘤1个,超声诊断符合率96.9%(31/32)。颈动脉体瘤的超声征象,肿瘤位于颈总动脉分叉处27个(84.4%),颈总动脉分叉后部5个(15.6%)。边界清楚30个(93.8%),边界不清2个(6.2%)。形态规整31个(96.9%),形态不规整(分叶状)1个(3.1%)。内部均呈不均匀低回声,可见迂曲管状结构29个(90.6%)。颈总动脉分叉角度增大并受压27个(84.4%),角度无改变5个(15.6%)。颈内、外动脉穿行于其内23个(71.9%),位于其外缘9个(28.1%)。彩色多普勒超声瘤内均探及丰富血流。结论颈动脉体瘤的超声表现具有一定的特征性,超声对颈动脉体瘤的诊断有很大的实用价值。

多层螺旋CT及CTA诊断颈动脉体瘤的价值

目的:探讨多层螺旋CT及CTA诊断颈动脉体瘤的价值。材料和方法:回顾性分析7例经病理证实的颈动脉体瘤多层螺旋CT平扫、增强扫描和CTA及3例DSA的影像资料。结果:7例共9个肿块(双侧2例),平扫肿块密度与肌肉相类似,增强扫描所有肿块均显著增强,薄层横断面图像能清晰显示被推移或包绕的颈内外动脉以及增宽的颈内、外动脉间距。8个肿块外周可见多发扩张的滋养动脉影。颈部CTA清晰显示7例9个肿块与颈总、颈内及颈外动脉的关系,其中7个肿块侧的颈动脉分叉呈杯口状扩大。3例CTA结果与DSA检查完全一致。结论:多层螺旋CT结合CTA可以替代DSA作为确诊颈动脉体瘤的最佳诊断方法。

颈动脉体瘤的超声诊断

目的 探讨彩色多普勒超声在颈动脉体瘤中的应用价值 ,分析超声仪器及超声医生经验与诊断的相关性。方法 总结 2 1例手术后病理证实的颈动脉体瘤患者的超声表现 ,用SPSS 10 .0统计学软件分析超声仪器及超声医生经验与诊断的相关性。结果 颈动脉体瘤表现为颈动脉分叉处低回声肿物 ,边界清晰有包膜 ,常包绕颈内、外动脉及颈内静脉等周围血管。颈内、外动脉受挤压可使两血管之间角度增大出现“金杯”征 ,肿瘤内部血流信号非常丰富。结论 超声医生的经验及彩色多普勒超声仪器可显著提高诊断水平。

颈动脉体瘤外科治疗并发症的分析

目的 :总结 46例颈动脉体瘤手术治疗结果以及并发症防治的经验。方法 :对采用肿瘤剥除术、同时切除颈外动脉术、与颈动脉分叉一并切除后血管重建术以及颈总动脉结扎术等方法治疗的颈动脉体瘤手术效果和并发症进行回顾性分析。结果 :手术切除率 91 3%。偏瘫 2例 ,舌下神经损伤 4例 ,舌咽神经损伤 2例 ,迷走神经损伤 1例 ,副神经损伤 1例 ,其中 1例同时有舌咽、迷走、舌下神经损伤。长期随访复发 2例 ,再次手术切除。所有病例无手术死亡。结论 :术前选择性血管造影、血管超声多普勒等检查以明确诊断 ,合理的Matas训练以及选择适当的术式 ,对于颈动脉体瘤外科治疗和减少并发症是必要的。

彩色多普勒超声在颈动脉体瘤诊治中的应用价值

目的 探讨彩色多普勒超声在颈动脉体瘤诊断、鉴别诊断中的应用价值及对临床治疗的指导作用。方法 回顾性分析 8例经手术及病理检查确诊为颈动脉体瘤患者的彩色多普勒超声图像特点 ,并对不同临床治疗方法与超声表现的关系进行分析。结果 彩色多普勒超声对 8例颈动脉体瘤均做出了准确诊断。肿块位于颈总动脉分叉处 ,颈总动脉分叉增宽 ,血供丰富是其主要特点。彩色多普勒超声图像特点与临床治疗方法间有一定的关系。结论 彩色多普勒超声不仅能对颈动脉体瘤做出明确诊断 ,而且对颈动脉体瘤的术式选择、术前准备、术后疗效观察等都具有较大的临床应用价值。

26例颈动脉体瘤的外科治疗体会

目的 :探讨颈动脉体瘤 (Carotidbodytumor,CBT)的诊断和治疗经验。方法 :2 6例患者 ,分别血管多普勒B超检测及单侧血管造影术或数字减影血管造影术 (Digitalsubtrasoundangiography,DSA) ,明确诊断。术前均行颈动脉压迫试验。手术治疗 ,其中瘤体剥离式切除 9例 ;颈外动脉同时切除 15例 ;颈内动脉部分切除 ,颈总、颈内人造血管搭桥术 1例 ;颈总动脉分叉处切除、颈内外动脉吻合 1例。结果 :除 2例合并脑部并发症并治愈 ,无 1例死亡。结论 :DSA对CBT的诊断最具权威性 ,术前颈动脉压迫训练 ,正确的术式选择是减少脑部并发症保证手术成功的关键。