Download PDF
Skull Base 2009; 19(1): 026-042
DOI: 10.1055/s-0028-1103126
© Thieme Medical Publishers

Combined Endovascular-Surgical Management of the Internal Carotid Artery in Complex Tympanojugular Paragangliomas

Mario Sanna1 , Paolo Piazza2 , Giuseppe De Donato1 , Roberto Menozzi2 , Maurizio Falcioni1
  • 1Gruppo Otologico Piacenza, Roma, Italy
  • 2Department of Neuroradiology, University of Parma, Parma, Italy
Further Information

Publication History

Publication Date:
12 January 2009 (online)

    Permissions and Reprints

ABSTRACT

The infratemporal fossa approach described by Fisch overcame most of the factors that had previously prevented the total removal of tympanojugular paragangliomas (TJP). The remaining problem has been infiltration of the internal carotid artery (ICA) for which there has been no entirely satisfactory solution. At the least, severe encasement risks the possibility of an arterial rupture at surgery. In order to reduce this risk, preoperative endovascular interventions have been employed—mainly balloon occlusion, with or without arterial bypass. Recently, intra-arterial stents to reinforce the encased segment of the ICA have been introduced. This study evaluates our experience with 20 patients affected by TJP in which the ICA has been subjected to preoperative interventions. Ten patients underwent a preoperative balloon occlusion and the other 10 patients had their ICAs reinforced with stents. Problems that arose during embolization necessitated that one patient with a stent required ligation of their ICA. No other problems were encountered during endovascular treatment or surgical resection. In one patient with a stent, it was impossible to establish a cleavage plane between their recurrent tumour and the ICA. These early results are encouraging and suggest that intra-arterial stents have a part to play in the surgical management of large TJPs.

KEYWORDS

Paraganglioma - glomus tumor - internal carotid artery - balloon occlusion - stent

REFERENCES

  • 1 Fisch U. The infratemporal fossa approach to tumors of the temporal bone and base of the skull.  J Laryngol Otol. 1978;  92 949-967
    CrossrefPubMedGoogle Scholar
  • 2 Andrews J C, Valavanis A, Fisch U. Management of the internal carotid artery in surgery of the skull base.  Laryngoscope. 1989;  99 1224-1229
    PubMedGoogle Scholar
  • 3 Zane R S, Aeschbacher P, Moll C, Fisch U. Carotid occlusion without reconstruction: a safe surgical option in selected patients.  Am J Otol. 1995;  16 353-359
    PubMedGoogle Scholar
  • 4 Sanna M, Piazza P, Ditrapani G, Agarwal M. Management of the internal carotid artery in tumors of the lateral skull base: preoperative permanent balloon occlusion without reconstruction.  Otol Neurotol. 2004;  25 998-1005
    CrossrefPubMedGoogle Scholar
  • 5 Christoforidis G, Valavanis A. Balloon occlusion of internal carotid artery.  Neurointerventionist. 2000;  2 95-102
    PubMedGoogle Scholar
  • 6 Urken M L, Biller H F, Haimov M. Intratemporal carotid artery bypass in resection of a base of skull tumor.  Laryngoscope. 1985;  95 1472-1477
    PubMedGoogle Scholar
  • 7 Sanna M, Khrais T, Menozi R, Piaza P. Surgical removal of jugular paragangliomas after stenting of the intratemporal internal carotid artery: a preliminary report.  Laryngoscope. 2006;  116 742-746
    CrossrefPubMedGoogle Scholar
  • 8 Cohen J E, Spektor S, Valarezo J, Fellig Y, Umansky F. Endolymphatic sac tumor: staged endovascular-neurosurgical approach.  Neurol Res. 2003;  25 237-240
    CrossrefPubMedGoogle Scholar
  • 9 Cohen J E, Ferrario A, Ceratto R, Miranda C, Lylyk P. Covered stent as an innovative tool for tumor devascularization and endovascular arterial reconstruction.  Neurol Res. 2003;  25 169-172
    CrossrefPubMedGoogle Scholar
  • 10 Nussbaum E S, Levine S C, Hamlar D, Madison M T. Carotid stenting and “extarterectomy” in the management of head and neck cancer involving the internal carotid artery: technical cases report.  Neurosurgery. 2000;  47 981-984
    CrossrefPubMedGoogle Scholar
  • 11 Fisch U, Mattox D. Microsurgery of the Skull Base. Stuttgart; Thieme 1988: 136-281
    Google Scholar
  • 12 Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome.  J Neurosurg. 2002;  97 1356-1366
    CrossrefPubMedGoogle Scholar
  • 13 Patel S J, Sekhar L N, Cass S P, Hirsch B E. Combined approach for resection of extensive glomus jugulare tumors.  J Neurosurg. 1994;  80 1026-1038
    CrossrefPubMedGoogle Scholar
  • 14 Witiak D G, Pensak M L. Limitations to mobilizing the internal carotid artery.  Ann Otol Rhinol Laryngol. 2002;  111 343-348
    PubMedGoogle Scholar
  • 15 Leonetti J P, Smith P G, Grubb R L. The perioperative management of the petrous carotid artery in contemporary surgery of the skull base.  Otolaryngol Head Neck Surg. 1990;  103 46-51
    PubMedGoogle Scholar
  • 16 Jackson C G, McGrew B M, Forest J A, Netterville J L, Hampf C F, Glasscock III M E. Lateral skull base surgery for glomus tumors: long-term control.  Otol Neurotol. 2001;  22 377-382
    CrossrefPubMedGoogle Scholar
  • 17 Moret J, Lasjaunias P, Théron J. Vascular compartments and territories of tympano-jugular glomic tumors.  J Belge Radiol. 1980;  63 321-337
    PubMedGoogle Scholar
  • 18 Sanna M, De Donato G, Piazza P, Falcioni M. Revision glomus tumor surgery.  Otolaryngol Clin North Am. 2006;  39 763-782
    CrossrefPubMedGoogle Scholar
  • 19 Sanna M, Jain Y, De Donato G, Rohit , Lauda L, Taibah A. Management of jugular paragangliomas: the Gruppo Otologico experience.  Otol Neurotol. 2004;  25 797-804
    CrossrefPubMedGoogle Scholar
  • 20 Sanna M, De Donato G, Russo A, Khrais T H. Middle ear and skull base glomus tumors: tympanic and tympanojugular paragangliomas. In: Wiet RJ Ear and Temporal Bone Surgery: Minimizing Risks and Complications. New York; Thieme 2006: 221-233
    Google Scholar
  • 21 Pareschi R, Righini S, Destito D, Raucci A F, Colombo S. Surgery of glomus jugulare tumors.  Skull Base. 2003;  13 149-157
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Chaturvedi S, Sohrab S, Tselie A. Carotid stent thrombosis: report of 2 fatal cases.  Stroke. 2001;  32 2700-2702
    PubMedGoogle Scholar
  • 23 Standard S C, Ahuja A, Guterman L R et al.. Balloon test occlusion of the internal carotid artery with hypotensive challenge.  AJNR Am J Neuroradiol. 1995;  16 1453-1458
    PubMedGoogle Scholar
  • 24 Mathews D, Walker B S, Purdy P D et al.. Brain blood flow SPECT in temporary balloon occlusion of carotid and intracerebral arteries.  J Nucl Med. 1993;  34 1239-1243
    PubMedGoogle Scholar
  • 25 Barker D W, Jungreis C A, Horton J A, Pentheny S, Lemley T. Balloon test occlusion of the internal carotid artery: change in stump pressure over 15 minutes and its correlation with xenon Ct cerebral blood flow.  AJNR Am J Neuroradiol. 1993;  14 587-590
    PubMedGoogle Scholar
  • 26 Brunberg J A, Frey K A, Horton J A, Deveikis J P, Ross D A, Koeppe R A. H2O positron emission tomography determination of cerebral blood flow during test occlusion of the internal carotid artery.  AJNR Am J Neuroradiol. 1994;  15 725-732
    PubMedGoogle Scholar
  • 27 Mathis J M, Barr J D, Jungreis C A et al.. Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases.  AJNR Am J Neuroradiol. 1995;  16 749-754
    PubMedGoogle Scholar
  • 28 Niimi Y, Berenstein A, Setton A, Kupersmith M J. Occlusion of the internal carotid artery based on a simple tolerance test.  Interventional Neuroradiol. 1996;  2 289-296
    PubMedGoogle Scholar
  • 29 Giller C A, Mathews D, Walker B, Purdy P, Roseland A M. Prediction of tolerance to carotid artery occlusion using transcranial Doppler ultrasound.  J Neurosurg. 1994;  81 15-19
    PubMedGoogle Scholar
  • 30 Vazquez Añon V, Aymard A, Gobin Y P et al.. Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects, cerebral monitoring and results.  Neuroradiology. 1992;  34 245-251
    CrossrefPubMedGoogle Scholar
  • 31 Van Rooij W J, Sluzewski M, Slob M J, Rinkel G J. Predictive value of angiographic testing for tolerance of therapeutic occlusion of the carotid artery.  AJNR Am J Neuroradiol. 2005;  26 175-178
    PubMedGoogle Scholar
  • 32 Abud D G, Spelle L, Piotin M, Mounayer C, Vanzin J R, Moret J. Venous phase timing during balloon test occlusion as a criterion for permanent internal carotid artery sacrifice.  AJNR Am J Neuroradiol. 2005;  26 2602-2609
    PubMedGoogle Scholar
  • 33 Timperman P E, Tomsick T A, Tew J M, van Loveren H R. Aneurism formation after carotid occlusion.  AJNR Am J Neuroradiol. 1995;  16 329-331
    PubMedGoogle Scholar
  • 34 Toma N, Matsushima S, Murao K et al.. Histopathological findings in a human carotid artery after stent implantation: case report.  J Neurosurg. 2003;  98 199-204
    PubMedGoogle Scholar
  • 35 Alexander M J, Smith T P, Tucci D L. Treatment of an iatrogenic carotid artery pseudoaneurysm with Symbiot covered stent: technical case report.  Neurosurgery. 2002;  50 658-662
    CrossrefPubMedGoogle Scholar
  • 36 Auyeung K M, Lui W M, Chow L CK, Chan F L. Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases.  AJNR Am J Neuroradiol. 2003;  24 1449-1452
    PubMedGoogle Scholar

Mario SannaM.D. 

Gruppo Otologico Piacenza, Via Emmanueli 42

29100 Piacenza, Italy

Email: mario.sanna@gruppootologico.it

      >