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Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations
- Source :
- Journal of Neurosurgery: Pediatrics. 23:325-332
- Publication Year :
- 2019
- Publisher :
- Journal of Neurosurgery Publishing Group (JNSPG), 2019.
-
Abstract
- OBJECTIVE Carotid body tumors (CBTs), extraadrenal paragangliomas, are extremely rare neoplasms in children that often require multimodal surgical treatment, including preoperative anesthesia workup, embolization, and resection. With only a few cases reported in the pediatric literature, treatment paradigms and surgical morbidity are loosely defined, especially when carotid artery infiltration is noted. Here, the authors report two cases of pediatric CBT and provide the results of a systematic review of the literature. METHODS The study was divided into two sections. First, the authors conducted a retrospective review of our series of pediatric CBT patients and screened for patients with evidence of a CBT over the last 10 years (2007–2017) at a single tertiary referral pediatric hospital. Second, they conducted a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of all reported cases of pediatric CBTs to determine the characteristics (tumor size, vascularity, symptomatology), treatment paradigms, and complications. RESULTS In the systematic review (n = 21 patients [includes 19 cases found in the literature and 2 from the authors’ series]), the mean age at diagnosis was 11.8 years. The most common presenting symptoms were palpable neck mass (62%), cranial nerve palsies (33%), cough or dysphagia (14%), and neck pain (19%). Metastasis occurred only in 5% of patients, and 19% of cases were recurrent lesions. Only 10% of patients presented with elevated catecholamines and associated sympathetic involvement. Preoperative embolization was utilized in 24% of patients (external carotid artery in 4 and external carotid artery and vertebral artery in 1). Cranial nerve palsies (cranial nerve VII [n = 1], IX [n = 1], X [n = 4], XI [n = 1], and XII [n = 3]) were the most common cause of surgical morbidity (33% of cases). The patients in the authors’ illustrative cases underwent preoperative embolization and balloon test occlusion followed by resection, and both patients suffered from transient Horner’s syndrome after embolization. CONCLUSIONS Surgical management of CBTs requires an extensive preoperative workup, anesthesia, and multimodal surgical management. Due to a potentially high rate of surgical morbidity and vascularity, balloon test occlusion with embolization may be necessary in select patients prior to resection. Careful thorough preoperative counseling is vital to preparing families for the intensive management of these children. ABBREVIATIONS BTO = balloon test occlusion; CBT = carotid body tumor; CN = cranial nerve; ECA = external carotid artery; ICA = internal carotid artery; MIBG = iodine-123-meta-iodobenzylguanidine; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Vertebral artery
Neck mass
External carotid artery
030204 cardiovascular system & hematology
Carotid Body Tumor
03 medical and health sciences
Postoperative Complications
Rare Diseases
0302 clinical medicine
Paraganglioma
medicine.artery
Preoperative Care
medicine
Humans
Anesthesia
030212 general & internal medicine
Embolization
Child
Retrospective Studies
Neck pain
Neck Pain
business.industry
General Medicine
medicine.disease
Combined Modality Therapy
Embolization, Therapeutic
Dysphagia
Cranial Nerve Diseases
Surgery
Child, Preschool
Female
medicine.symptom
Internal carotid artery
Deglutition Disorders
business
Subjects
Details
- ISSN :
- 19330715 and 19330707
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Journal of Neurosurgery: Pediatrics
- Accession number :
- edsair.doi.dedup.....16b397e9b2badbaf21157e8e29b4a55f
- Full Text :
- https://doi.org/10.3171/2018.8.peds18393