Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China.
Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, China.
Ear Nose Throat J. 2023 Jun;102(6):362-368. doi: 10.1177/01455613211009441. Epub 2021 Apr 8.
Extirpation of multiple head and neck paragangliomas carries challenge due to close anatomic relationships with critical neurovascular bundles.
This study aims to assess whether the application of 3-D models can assist with surgical planning and treatment of these paragangliomas, decrease surgically related morbidity and mortality.
Fourteen patients undergoing surgical resection of multiple head and neck paragangliomas were enrolled in this study. A preoperative 3-D model was created based on radiologic data, and relevant critical anatomic relationships were preoperatively assessed and intraoperatively validated.
All 14 patients presented with multiple head and neck paragangliomas, including bilateral carotid body tumors (CBT, n = 9), concurrent CBT with glomus jugulare tumors (GJT, n = 4), and multiple vagal paragangliomas (n = 1). Ten patients underwent genomic analysis and all harbored succinate dehydrogenase complex subunit D (SDHD) mutations. Under guidance of the 3-D model, the internal carotid artery (ICA) was circumferentially encased by tumor on 5 of the operated sides, in 4 (80%) of which the tumor was successfully dissected out from the ICA, whereas ICA reconstruction was required on one side (20%). Following removal of CBT, anterior rerouting of the facial nerve was avoided in 3 (75%) of 4 patients during the extirpation of GJT with assistance of a 3-D model. Two patients developed permanent postoperative vocal cord paralysis. There was no vessel rupture or mortality in this study cohort.
The 3-D model is beneficial for establishment of a preoperative strategy, as well as planning and guiding the intraoperative procedure for resection of multiple head and neck paragangliomas.
由于与关键的神经血管束密切相关，因此多处头颈部副神经节瘤的切除具有挑战性。
本研究旨在评估 3-D 模型的应用是否可以协助这些副神经节瘤的手术规划和治疗，降低手术相关的发病率和死亡率。
本研究纳入了 14 例接受多处头颈部副神经节瘤切除术的患者。根据影像学数据创建了术前 3-D 模型，并在术前评估和术中验证了相关的关键解剖关系。
所有 14 例患者均表现为多发性头颈部副神经节瘤，包括双侧颈动脉体瘤（CBT，n = 9）、同时存在 CBT 和颈静脉球瘤（GJT，n = 4）和多发性迷走副神经节瘤（n = 1）。10 例患者进行了基因组分析，均携带琥珀酸脱氢酶复合物亚单位 D（SDHD）突变。在 3-D 模型的指导下，有 5 侧手术侧的颈内动脉（ICA）被肿瘤环绕包裹，其中 4 例（80%）成功地从 ICA 上分离出肿瘤，而有 1 例（20%）需要 ICA 重建。在 CBT 切除后，4 例 GJT 切除中，有 3 例（75%）在 3-D 模型的辅助下避免了面神经的前置改道。2 例患者术后出现永久性声带麻痹。本研究队列中无血管破裂或死亡。
3-D 模型有利于建立术前策略，规划和指导多发性头颈部副神经节瘤切除术的术中过程。
