Anestesia e Pesquisa Clínica
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Radioguided Surgical Resection of Carotid Body Tumors

Ombretta Martinelli, Mauro Fresilli, Alessia Alunno, Luigi Irace, Salvatore Venosi and Bruno Gossetti

Aim: We present our experience about surgical resection of Carotid body tumor (CBT) and to define the role of colour coded ultrasound (CCU) and of somatostatin receptor scintigraphy (SRS) with Indium-111-DTPA-pentreotide (Octreoscan) using both planar and single photon emission tomography (SPECT) technique.
Methods: Twenty-three patients suffering from 27 CBTs were treated from 1997 to 2014. Preoperative investigations included CCU and SRS-SPECT. All tumours were grouped according to Shamblin's classification. Intraoperative radiocaptation by Octreoscan was also carried out in all cases to evaluate the radicality of surgery.
Results: Preoperatively CCU showed CBTs with sensitivity 100%. Radioisotope imaging identified the CBTs as carotid body tumors in 25 cases while no radio isotopic uptake was detected in 2 cervical vagal schwannoma. Combined data from CCU and SPECT allowed determining tumour size in order to select 12 larger tumours. Intraoperative Octreoscan demonstrated microscopic tumour leftovers promptly removed in 2 cases and an unrespectable remnant at the base of skull in another case. During follow-up (6 months-10 years, mean 3.9 years) CCU and radioisotope scans showed no recurrence in 25 cases, a slightly enlargement of that intracranial residual as detected during surgery in 1 patients and a little recurrence in another one case.
Conclusion: CCU may allow an early and noninvasive detection of CBTs and hence safer operations. The combined use of CCU and SPECT provide useful data to identify that tumour and to evaluate their extent and carotid arteries infiltration. Radioisotope imaging is a sensitive modality to detect metastases and lymph node involvement that are markers of CBT malignancy. Mid and long terms results in terms of recurrence and carotid repairs patency seems very encouraging with this approach. After surgery CCU and SPECT seem to be accurate modalities for surveillance for an early detection of CBTs recurrence.