DIAGNOSIS OF CAROTID PARAGANGLIOMA: MULTIDISCIPLINARY ASPECTS

Abstract

Objective: to enhance the efficiency of diagnosis and treatment of carotid paragangliomas, by introducing of a multidisciplinary approach into clinical practice.Material and methods. A total of 15 cases of paragangliomas have been followed up for 10 years. The age of the patients was 18 to 58 years (mean age 38±12 years). Primary multiple sites of chemodectomas were noted in 2 cases. Bilateral involvement was observed in one case. In the other, two unilateral vascular tumors successively developed with an interval of almost 6 years. A set of studies was conducted, which embraced ultrasound duplex scanning (USDS) of the neck vessels, computed tomography (CT), and selective carotid angiography (SCAG) in various combinations. The investigators made a successive examination of the symmetrical areas of the face and neck and polypositional scanning of the zone of interest and studied quantitative parameters, including linear blood flow velocity (LBFV) and volumetric blood flow velocity. Native and contrast-enhanced X-ray CT and magnetic resonance imaging (MRI) were carried out. SCAG was performed as digital subtraction angiography.Results. USDS can confirm the hypervascular nature of the tumor and its close relationship with the carotid artery branches and measure blood flow velocity (LBFVmean, 0.46 m/sec). X-ray CT and MRI examinations in combination with vessel contrasting make it possible to accurately determine the localization and topography of the tumor, its association with the carotid artery system and to type afferent vessels. SCAG is a highly informative technique that can identify the afferent vessels of the tumor and its relationship with the great vessels and, if technically possible, perform selective microembolization of the afferent tumor vessels, which will further facilitate surgical treatment, reducing the risk of intraoperative bleeding. Conclusion. The multidisciplinary approach to diagnosing carotid paragangliomas in the maxillofacial area and neck makes it possible to determine the type, size, and velocity characteristics, to verify the diagnosis, and to work out optimal treatment policy. Among the non-invasive techniques, CT angiography and MR angiography are most valuable for final diagnosis. Selective angiography of the branches of the external carotid arteries remains the gold standard and is the final and most important stage of the study, which make it possible to detail angioarchitectonics, to determine afferent vessels, and to plan further treatment, including endovascular embolization. The diagnosis of carotid paragangliomas requires a multidisciplinary approach with the equal attraction of endovascular diagnosis and treatment specialists, maxillofacial surgeons, angiologists, ultrasound and radiology diagnosticians, and pathologists both at the stages of diagnosis and subsequent treatment. This problem can be effectively solved in a multidisciplinary hospital that has skilled staff with sufficient clinical experience in diagnosing vascular masses and is equipped with modern equipment, which allows optimization of further treatment.

Keywords

• carotid paraganglioma
• chemodectoma
• ultrasound duplex scanning
• computed tomography
• magnetic resonance imaging
• selective carotid angiography
• multidisciplinary approach.