Ortega Valeria, Calderon Julio, Ahumada Fernando, Quiroz Alfaro Alejandro José, Diaz Orlando
Department of Radiology, Baylor College of Medicine, Texas, United States.
Department of Interventional Neuroradiology, Houston Methodist Hospital, Houston, Texas, United States.
Surg Neurol Int. 2024 Nov 29;15:446. doi: 10.25259/SNI_693_2024. eCollection 2024.
The occurrence of secondary vascular pathology in paragangliomas is extremely rare, particularly in carotid body tumors (CBTs).
A 73-year-old female presented with computed tomography angiography revealing a right CBT with a large intratumoral contrast collection. Digital subtraction angiography confirmed a CBT with an internal carotid artery (ICA) intratumoral pseudoaneurysm. Interventional neuroradiology performed coil embolization of the pseudoaneurysm, and a covered stent was placed in the ICA. Surgical intervention was deferred, and the patient was closely monitored with Doppler ultrasound.
Diagnostic imaging is crucial in the management of CBT, offering detailed assessment of tumor morphology and their anatomical relationships, particularly in identifying coexisting vascular anomalies. Recognition of vascular pathologies, such as intratumoral pseudoaneurysms, is critical, as failure to do so could lead to life-threatening complications, including severe bleeding during surgical resection. In cases where surgical resection is high risk due to tumor classification or patient comorbidities, palliative endovascular treatment presents a viable alternative. This approach not only reduces tumor vascularity and provides symptomatic relief but also minimizes procedural risks. While surgical resection remains the gold standard for complete tumor removal, embolization serves as an option in complex or inoperable cases and may also be used to reduce intraoperative risks when surgery is feasible.
副神经节瘤中继发性血管病变极为罕见，尤其是在颈动脉体瘤（CBT）中。
一名73岁女性，计算机断层血管造影显示右侧CBT伴有肿瘤内大量造影剂聚集。数字减影血管造影证实为CBT伴颈内动脉（ICA）肿瘤内假性动脉瘤。介入神经放射学对假性动脉瘤进行了弹簧圈栓塞，并在ICA内放置了覆膜支架。推迟了手术干预，通过多普勒超声对患者进行密切监测。
诊断性影像学检查在CBT的管理中至关重要，可对肿瘤形态及其解剖关系进行详细评估，尤其是在识别并存的血管异常方面。识别血管病变，如肿瘤内假性动脉瘤，至关重要，因为未能识别可能导致危及生命的并发症，包括手术切除期间的严重出血。在因肿瘤分类或患者合并症而手术切除风险较高的情况下，姑息性血管内治疗是一种可行的选择。这种方法不仅可减少肿瘤血管供应并缓解症状，还可将手术风险降至最低。虽然手术切除仍然是完全切除肿瘤的金标准，但栓塞在复杂或无法手术的病例中是一种选择，并且在手术可行时也可用于降低术中风险。
