48 year old female, presenting with a right sided neck swelling. First noted 3 years ago, but has been slowly growing since then.
No significant PMH, patient is entirely fit and well.
Examination reveals a firm, non-compressible swelling in the right side of the neck.
MR angiogram of the aortic arch and great vessels, as well as a diagnostic angiogram was performed
1. What is your clinical diagnosis? What diagnostic sign did you use to reach that diagnosis?
2. What is the classification used for this lesion?
3. What is your treatment strategy for this patient?
Thank you Dr Peter, my only disagreement would be the Shamblin grading of this lesion as it surrounds the ICA and ECA completely at certain points
١ carotid body tumour
Splaying bifurcation
2 shamblian 3 encircling both I can eca
3 excision mass inter position graft ica sacryficing exa
Thank you Dr Mohamed
1. What is your clinical diagnosis? What diagnostic sign did you use to reach that diagnosis?
Carotid body tumor Characteristically splays carotid bifurcation
2. What is the classification used for this lesion?
Shamblin classification II partially encasing ICA & ECA
3. What is your treatment strategy for this patient?
Surgical excision with possibility of bypass
Thank you Dr Mina. What do you mean by possibility of bypass? What would be the alternative if you need to resect the CCA bifurcation?
Thank you Dr Eman and Dr Abdullah
I agree with your answers, can you elaborate more on pre-operative embolization and any evidence behind it?
Embolization of eca as sacrifycing or for cbt it self for bleeding and other complication
Preoperative embolization in CBTs is a safe and effective preoperative strategy in large carotid paragangliomas, rarely leading to neurologic complications. Criteria for optimized selection of patients to develop individualized preoperative strategies and clear recommendations on candidates for embolization have yet to be identified. Because of the rarity of the tumor, a randomized trial is difficult to organize.
Preoperative embolization decrease blood loss intraoperatively
Texakalidis P, Charisis N, Giannopoulos S, Xenos D, Rangel-Castilla L, Tassiopoulos AK, Jabbour P, Grossberg JA, Machinis T.
Role of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis.
World Neurosurg. 2019 Sep;129:503-513.e2. doi: 10.1016/j.wneu.2019.05.209. Epub 2019 May 30. PMID: 31154101.
Thank you Drs. This approach is fiercely advocated by some, and others consider it unnecessary. Which is why this paper you mentioned is very interesting Dr Mina, and a more recent publication in 2023 looked into this based on Shamblin classification, advocating this approach even further in the more extensive tumors.
Q1.CBT sign is splaying or lyres sign
Q2. Shamblin classification type 3?
Q3. CBT resection + ineterpsition graft-+ ECA embolization
١ carotid body tumour
Splaying bifurcation
2 shamblian 3 encircling both I can eca
3 excision mass inter position graft ica sacryficing exa