Cirurgia híbrida na exérese de tumor glômico Shamblin II

Alexandre Campos Moraes Amato,Ricardo Virgínio Dos Santos,Marielly Ayako Uemura,Diego Daniel Gomes Ferreira,Fernanda Teixeira Fonseca Da Silva,Thais De Oliveira Stucchi

doi:10.1590/1677-5449.012218

Alexandre Campos Moraes Amato, Ricardo Virgínio Dos Santos + Show 4 more

Open Access

https://doi.org/10.1590/1677-5449.012218

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Abstract

Glomus tumors are rare benign neoplasms originating from paraganglionic cells of the neural crest developing in the adventitious layer of the vessel. They are nonencapsulated and highly vascularized. A 64-year-old female patient was identified with a hypervascularized glomus tumor measuring 5 cm, posterior to the left carotid bifurcation and contralateral carotid occlusion. We performed preoperative embolization via endovascular access followed by direct percutaneous puncture, guided by angiography, to fill the remaining area. After embolization, surgical excision of the tumor was performed with reduced bleeding and it was easier to find the cleavage planes to adjacent structures. At late follow-up, the patient is free from tumor recurrence. The tumor was classified as Shamblin II, measuring 4 to 6 cm with moderate arterial insertion. Through this double approach we observed a relative reduction in intraoperative bleeding and improved identification of the cleavage plane, facilitating excision and avoiding surgical clamping.

Highlights

Glomus tumors are rare benign neoplasms that originate from paraganglionic neural crest cells developing in the paravertebral region and can affect cervical blood vessels, cranial nerves, and the autonomic nervous system, with an incidence of 1:30,000.1,2 This type of tumor accounts for 60-70% of paragangliomas of the head and neck, they are highly vascularized and, well-delineated, they are not encapusulated and proximity with important structures, such as nerves, combined with dense vascularization make resection difficult.[2,3,4]
Carotid glomus tumors arise from paraganglion cells and develop in the adventitial layer of the vessel, at the bifurcation of the common carotid artery, in a posteromedial position
After a series of case studies, in 1971, Shamblin et al published a classification of glomus tumors, categorized by size and degree of invasion of the vessel wall.[12,13]

Summary

Cirurgia híbrida na exérese de tumor glômico Shamblin II

Alexandre Campos Moraes Amato1,2 , Diego Daniel Gomes Ferreira[3], Fernanda Teixeira Fonseca da Silva[3], Marielly Ayako Uemura[3], Thais de Oliveira Stucchi[3], Ricardo Virgínio dos Santos[2]

INTRODUCTION

CASE DESCRIPTION

DISCUSSION

Findings

Correspondence Alexandre Campos Moraes Amato