R: [HSF] Carotid paraganglioma

[erdinç naseri]

Dear Dr. Siclari,
THanks for the recommendations.
1.There is no obvious feeding artery
2.The circle of Willis is complete radiologically without any obstructive lesions in any of its supplying arteries.This means that she would tolerate unilateral clamping for reasonable periods.
3.We use cartiod shunts in almost all carotid cases.
4.The present case could only be resected if we were to sacrifice the nerves and then only partially because of very upward extension of the tumor around ICA.
Erdinc> Subject: R: [HSF] Carotid paraganglioma> Date: Wed, 23 Jan 2008 15:27:08 +0100> From: siclari at cardiocentro.org> To: OpenHeart-L at lists.hsforum.com> CC: > > I have operated some cases. Sometimes they can be very difficult because of the extension and the necessity of clamping for a considerable time the carotid system. What we usually do is first to assess angiographically if there are feeding arteries. If present, these can be embolized by expert neuro-radiologists by intravascular injections of Gelfoam and/or implantations of microcoils. Neuroradiologists may also preoperatively assess, by means of a temporary occlusion baloon, the safety of carotid occlusion. The glomus tumor shrinks considerably (experts say in up to 60% of the cases) and can be then operated without excessive blood loss. In some cases H & N surgeons or neurosurgeons should be involved to achieve radicality and reduce the incidence of cranial nerve lesions.> > > PD Dr. med Francesco Siclari> Head Cardiac Surgery> Cardiocentro Ticino> via Tesserete 48> CH -6900 Lugano> siclari at cardiocentro.org> > > -----Messaggio originale-----> Da: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-bounces at lists.hsforum.com] Per conto di erdinç naseri> Inviato: lunedì, 21. gennaio 2008 18:30> A: openheart-l at lists.hsforum.com> Oggetto: [HSF] Carotid paraganglioma> > > > Opinion required about the following case:> 52 Y/O female with R TMJ pulsatile mass diagnosed as glomus tumor applied for surgery.DSA: tumor blush encircling carotid bifurcation and both branches.Cervicocranial MR( 1.5 months ago):mass encircling carotid bifurcation and branches but not behind the mandible.Operated today: mass encircling the above mentioned structures but also hypoglossal nerve extending behind TMJ , posterior belly of digastric behind submandibular gland. Very fragile .Couldn't find a plane for safe seperation.En bloc exicision with ICA was neccessary but distal ICA was inaccessible. Did nothing. Radiotherapy? > Erdinc> PS:In our center glomus tumor of this magnitude is treated by Cardiovascular surgeons. > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------