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Title: CHEMODECTOMA – A JOURNEY FROM EMBOLIZATION TO EXCISION
e-poster Number: EPOS 7
Category: e Poster
Author Name: Dr. Aayush Mathur
Institute:
Co-Author Name:
Abstract :
INTRODUCTION
Carotid body tumors are part of the paraganglioma family, seen at the carotid bifurcation with peculiar splaying of the ICA and ECA. MRI is highly sensitive for diagnosis, while surgical excision stands as the foremost treatment of choice. They can often encase adjacent neurovascular structures and thereby; super-selective embolization of vascular feeders has been used effectively to reduce tumour vascularity and bulk.
CASE DESCRIPTION
During evaluation for a painless neck swelling, a 14-year-old girl child underwent contrast CT which helped localize a highly vascular lesion sitting at the bifurcation of left common carotid artery. It showed > 270-degree encasement of ICA (Shamblin grade III); wherein the surgeons were concerned about the need for ICA sacrifice. Child was planned for balloon occlusion test and pre operative embolization in IR suite.
RESULTS
Bilateral femoral punctures were performed and access secured. Balt – Copernic balloon was inflated at the vertical segment of ICA for 10 minutes and subsequent runs were taken from the contralateral ICA and vertebral arteries. Patient was also clinically evaluated on table for any focal neurological deficits during balloon occlusion.
BTO showed good cross circulation with adequate filling of left ACA from A-com and left MCA through P-com.
DSA revealed multiple tiny feeding branches arising from both ICA and ECA. Trans -arterial embolization was not feasible in view of difficulty in super-selective cannulation of tiny feeders. Henceforth, ultrasound guided percutaneous puncture of tumour was performed using 22G- Chiba needle followed by embolization using 50 % NBCA – lipiodol combination under fluoroscopic guidance.
Surgical resection was successful without the need for ICA sacrifice due to relative ease in dissection as a result of good tumour devascularization.
CONCLUSION
Shamblin grade III CBTs pose challenge to surgeons owing to difficult surgical planes and questioning ICA sacrifice. Pre operative embolization can lead to good surgical outcomes and predict post procedure morbidity.
