Treatment of Cervical Paraganglioma
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A neck paraganglioma disrupts blood flow through the blood vessels and compresses the organs. Although the disease progresses slowly, this is treated as soon as it is detected. Doctors abroad perform safe operations to remove a neck paraganglioma. They remove the tumor with partial carotid artery removal or prosthetic repair, if required. Preoperative embolization may be performed to reduce the risk of complications. Radiation therapy can sometimes be provided after surgery to reduce the risk of a recurrence.
Content
- What is a paraganglioma?
- Diagnostics
- Surgical treatment of paraganglioma of the neck
- Embolization
- Radiation therapy
- Where to undergo treatment?
What is a paraganglioma?
A paraganglioma (chemodectoma) is a neuroectodermal tumor that grows from sympathetic and parasympathetic ganglia. This is among the rare tumors, which most often develop in the neck. Approximately 60% of paragangliomas are found in the carotid sinus, a collection of nerve cells near the carotid artery that regulate blood pressure and heart rate, depending on blood gas indicators.
As the tumor grows, this does not invade large blood vessels, but compresses them, so blood flow in the jugular vein and carotid artery is often disturbed. Other organs, such as the pharynx, trachea, thyroid gland, and glossopharyngeal nerves, can also be compressed.
Paragangliomas grow very slowly. However, they inevitably progress, and, without treatment, they can reach gigantic proportions. Therefore, when this tumor is detected, patients are immediately referred for surgery, without any follow-up period. The longer the disease progresses, and the larger the tumor becomes, the more difficult it is to remove this neoplasm.
Diagnostics
A tumor is usually located in the lateral neck, below the angle of the lower jaw bone. As it grows, patients have complaints that cause a visit to a doctor: a pulsating volumetric mass, pain on palpation, heaviness in the neck, a sensation of a foreign body in the throat, and impaired swallowing.
Some paragangliomas produce hormones called catecholamines. These cause headaches, high blood pressure, and bouts of dizziness.
Paragangliomas are often diagnosed late. In countries with poorly developed medicine, the frequency of diagnostic errors reaches 90%.
The basis of diagnostics is imaging methods. The tumor is visualized using CT or MRI scans.
The most informative method is a CT scan. A typical sign of the tumor is an expansion of the bifurcation of the common carotid artery. Doctors see a volumetric soft tissue lump with clear boundaries, located in the middle third of the neck. In 8% of cases, paragangliomas reach a large size and spread to the upper third of the neck.
Other diagnostic methods include:
- a neck MRI scan;
- an ultrasound scan of the brachiocephalic arteries (as the first diagnostic method after a patient's visit to a doctor, but then CT or MRI scans will be conducted to clarify the diagnosis);
- a needle biopsy is rarely performed, only if there is a doubt about the diagnosis, since this procedure is not safe for the neck paraganglioma.
Surgical treatment of paraganglioma of the neck
Most patients undergo surgical treatment. A successful operation cures the disease completely. The risk of a metastasis spread or a recurrence is about 10%.
The operation is performed in the area of the carotid triangle. This is a complex area, so it is important to use the services of a highly trained and experienced surgeon to remove the tumor without any complications.
Surgical options:
Subadventitial tumor resection is a surgical procedure performed at an early stage, if the tumor is localized and minimally united with the carotid artery. Neoplasms up to 2 cm that have not spread beyond the bifurcation zone of the carotid artery are usually treated with this technique. Doctors remove the tumor itself, but completely preserve the carotid artery. There is no need to open its walls.
It is important for a doctor to perform all manipulations on the carotid artery wall very carefully, because even without damage to the artery wall, dangerous complications are possible when removing the paraganglioma. For example, blood clots may appear inside the internal carotid artery if an atherosclerotic plaque comes off or the blood vessel wall is crushed by instruments. In addition, when performing surgery, doctors must avoid damage to the hypoglossal and glossopharyngeal nerves.
External carotid artery resection is necessary for the treatment of paraganglioma of the neck, if it covers the trunk of the carotid artery, invading not only the adventitia, but also the muscle layer. That is, in cases where tumor separation without opening the external carotid artery wall is impossible. This is often established already during the operation, since imaging diagnostic methods cannot visualize the vessel wall in layers.
When performing the operation, doctors expose the carotid artery wall and ligate it. If it is impossible to isolate at least 0.5 cm of the blood vessel, a vascular clamp will be applied instead of ligation. Then the tumor and a part of the blood vessel will be removed using an en bloc technique. The branches of the carotid artery will be ligated. A vascular suture will be applied to the defective area.
Internal carotid artery transplant is the most complex operation. The need for this surgical intervention occurs in 3% of patients with paragangliomas. For the operation to be a success and for minimizing the risk of complications, it is important that the surgical team has a doctor with extensive experience in performing interventions on the brachiocephalic arteries.
The need for internal carotid artery transplants arises in cases where the paraganglioma covers its trunk by more than two-thirds and grows into the muscular wall. This means that when trying to isolate the neoplasm, a rupture of the blood vessel wall will inevitably occur. Arterial prosthetic repair can be performed if a tumor-free site is located at least 15 mm from the base of the skull. A part of the blood vessel is removed, and a graft is placed in this area. This may be a patient's own vein, and a prosthesis made of artificial materials can sometimes be placed.
Embolization
Before surgical treatment of paraganglioma of the neck, a doctor may perform a procedure to reduce the blood supply to the tumor. This procedure is called embolization. The term itself means a block of the blood vessels.
Embolization can be performed for tumors larger than 3 cm. This procedure reduces bleeding during surgery. Accordingly, blood loss is reduced, patients are less likely to need blood transfusions and feel better after surgery.
Embolization is a minimally invasive procedure done through an incision in the leg. Doctors deliver emboli through the blood vessels: these can be both liquid substances and solid particles (for example, polyvinyl alcohol) with a diameter of 140-250 microns. Sometimes it is necessary to clog several vessels, and, in the case of single-component tumors, embolization of a single artery supplying the tumor may be sufficient.
Embolization is carried out 2-3 days before surgery. As a result, the tumor size decreases, and the blood flow in it is depleted. A surgical intervention is performed after local swelling, caused by tissue damage as a result of embolization, subsides.
Radiation therapy
Radiation therapy is rarely used for the treatment of paraganglioma. The neoplasm belongs to radioresistant tumors, so the effectiveness of the method is low.
Radiation therapy may be used in the following cases:
- after tumor removal surgery to reduce the risk of a recurrence;
- instead of surgery to control the tumor in patients for whom surgical treatment is contraindicated.
The complexity of radiation therapy for neck paragangliomas is that the tumor is surrounded by many organs, large blood vessels, and nerves. Therefore, it is important for radiotherapy to be very precise. Otherwise, severe complications are possible, up to strokes due to radiation damage to the carotid artery and the formation of blood clots in it. Treatment abroad gives an opportunity to benefit from the latest radiotherapy options, which ensure high treatment safety. Modern linear accelerators make it possible to deliver radiation exactly to the tumor, avoiding significant radiation exposure to surrounding tissues.
Where to undergo treatment?
You can undergo your treatment of paraganglioma of the neck abroad, in one of the countries with advanced medicine. The Booking Health specialists will help you to choose the most suitable hospital and organize your trip. There are a few reasons for you to opt for treatment abroad:
- high-precision diagnostics allows doctors to establish a diagnosis with imaging methods, without a biopsy;
- foreign countries have specialized centers with extensive experience in the treatment of rare tumors, including neck paragangliomas;
- highly qualified surgeons perform safe operations on the neck organs;
- a minimal risk of damage to the nerves and large blood vessels during surgery;
- doctors perform operations of any complexity, including tumor removal with carotid artery prosthetic repair;
- surgery is preceded by embolization of the blood vessels supplying the tumor to reduce the risk of complications and reduce blood loss;
- most neck paragangliomas can be cured completely, and they do not recur in the future;
- foreign hospitals use modern types of radiation therapy, which are very accurate and destroy the tumor with minimal exposure to the nearby healthy organs and tissues.
You are welcome to use the Booking Health service to make an appointment for your treatment abroad. The company's website presents the best hospitals in Europe and worldwide. You can compare the cost of treatment in different centers to undergo your treatment at the best price. Please leave your request on the website, and the specialists of the Booking Health company will contact you within a few hours. When making your treatment appointment through our service, the cost of treatment will be lower due to the lack of additional fees for foreign patients.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
National Center for Biotechnology