Shamblin Classification Research Articles

Carotid baroreceptor dysfunction after carotid body tumour resections

ObjectiveCarotid body tumours (CBTs) and baroreceptor failure (BRF) are two distinct but interrelated conditions, affecting the carotid body and its regulatory mechanisms. We aim to describe and quantify BRF after unilateral and bilateral CBT resections. MethodsProspective cohort study. We included all patients with unilateral or bilateral CBT undergoing resection from April 2021 to January 2023. Demographics and CBTs characteristics were analysed; baroreceptor sensitivity assessment was conducted using the Composite Autonomic Severity Score (CASS). Statistical analyses were performed using R. Significance level was set at a 2-tailed α = 0.05. ResultsA total of 30 patients with CBT underwent surgical resection, twenty-three were included in the study (18 unilateral and 5 bilateral CBTs). All 23 (100 %) were females, median age of 60 years. Regarding patients with unilateral CBT; preoperatively, 13 had BRF, the most common dysfunction subtype was mixed. Postoperatively, the most common dysfunction subtype was sympathetic failure. With regards to bilateral CBTs; 2 patients did not have autonomic dysfunction preoperatively. After bilateral surgical resection one patient remained without autonomic dysfunction; however, all other patients persisted with BRF. ConclusionBRF was present in 13 patients with unilateral CBT and 3 patients with bilateral tumours preoperatively; most will remain with BRF and will only change the characteristics postoperatively. No associations were found between type, severity of BRF and Shamblin classification or laterality. It is paramount that research in this area continues as many features are yet unknown regarding CBT pathogenesis, hence, BRF may be present yet not affect significantly quality of life.

Surgical and Histopathological Results in Carotid Body Tumors.

The possible relationships between the histopathological findings of carotid body tumors and age, gender, tumor diameter, and Shamblin classification were investigated. In addition, preoperative embolization status, development of neurological complications, need for vascular reconstruction, hemoglobin change, and discharge time were examined and the effects of these variables on each other were analyzed. Between 2008 and 2022, 46 cases who underwent carotid body tumor excision were examined retrospectively. The cases were followed for an average of 81 months postoperatively. Histopathological materials were reexamined and the effect of categorical variables was analyzed. Mean tumor diameter was 3.55 ± 1.26 cm, mean discharge time was 3.91 ± 2.37 days, and mean hemoglobin change was 1.86 ± 1.25. Neurological complications developed in 13% of cases. The amount of hemoglobin change was significantly (p = 0.003) higher in those who developed neurological complications, whereas the tumor diameter and discharge time were found to be insignificantly higher. Surgical complications requiring vascular repair occurred in 10.8% of cases. Tumor diameter (p = 0.017) and hemoglobin change (p = 0.046) were significantly higher in these patients. There were significant correlations between higher Shamblin classification and tumor diameter, discharge time, postoperative hemoglobin value, and number of surgical and neurological complications. No significant difference was found between Ki-67, capsular invasion, mitosis, pleomorphism, prominent nucleoli, mean island diameter, and tendency of islands to merge with categorical variables. As the tumor diameter increases, the operation becomes more difficult and the postoperative complication rate increases. We think that subadventitial and capsular removal of the tumor is effective in preventing recurrence. To reach a histopathological conclusion, a larger series of studies including tumors with high Ki-67 and mitosis rates, large size, and one or more of the criteria for necrosis are needed.

Fifteen Years of Experience with Surgical Management of Bilateral Non-familial Carotid Body Tumors

Bilateral carotid body tumors (CBTs) clinical manifestation is infrequent. We conducted this work to describe our experience in the surgical treatment of bilateral CBT and to analyze our results. A retrospective, observational study. We analyzed the totality of bilateral CBT resections that had been performed in our institution from January 2008 to September 2023. Data was obtained from medical records and anonymized, ethics approval was obtained from our institution committee. As the number of observations was less than those required by the central limit theorem our sample was considered nonparametric. Statistical analysis was performed on Stata17. We evaluated 16 patients with a total of 32 CBT; surgical resection was performed in 28 cases (87.50%). Median age of the patients was 60years (interquartile range [IQR] 46-64). Regarding the Shamblin classification, 9 CBTs (32.14%) were classified as Shamblin I, 11 (39.29%) as Shamblin II, and 8 (28.57%) as Shamblin III. The median Distance to the Base of the Skull (DTBOS) was 3.5cm (IQR 2.7-5.1), and the median tumor volume was 11.25cc (IQR 3.4-18.7). The median bleeding volume was 300ml (IQR 200-500), and the median surgical time was 190min (IQR 145-240). All surgeries were performed using the Retrocarotid Dissection technique. We documented 9 (32.14%) cases of nerve injuries, all of which were transitory. In the median regression a statistically significant association was found between DTBOS, Shamblin classification and tumor volume with intraoperative bleeding and length of stay. Surgical treatment remains safe and should be considered the gold standard for accurate histologic diagnosis. DTBOS and tumor volume, in addition to Shamblin classification, must be considered in preoperative planning to predict bleeding and hospital stay.

The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis

BackgroundComputed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide accurate vascular imaging information, but their use may be contraindicated. Color Doppler ultrasonography (CDU) provides simple, safe, noninvasive, and reproducible imaging. We therefore investigated the role of preoperative CDU combined with CTA and MRA in the quantification, typing, and diagnosis of carotid body tumors (CBTs).MethodsWe retrospectively analyzed patients with CBTs categorized into group A (type I [n = 1] and type II [n = 10]) or group B (type III [n = 56]) per the intraoperative Shamblin classification. CDU, CTA, and MRA characteristics of CBTs were observed, surgical results were correlated, and the diagnostic threshold of the CBT classification was calculated.ResultsCBTs were usually located at the common carotid artery bifurcation, encircling the carotid artery. An increased angle was found between the internal and external carotid arteries. On CDU, CBTs primarily presented as homogeneous hypoechoic masses with clear boundaries, rich flow signals, and a high-speed, low-resistance artery-like flow spectrum. CTA showed uniform or heterogeneous marked enhancement. MRA showed mixed T1 and slightly longer T2 signals and uniform or uneven obvious enhancement. With increases in the lesion size, amount of blood transfused, and operation time, the intraoperative classification level and possibility of skull-base invasion increased. When the maximum diameter of the lesion, the volume of the tumor, the distance between the upper margin of the tumor to the mastoid and the mandibular angle were 3.10 cm, 10.15 cm3, − 3.26 cm, and 0.57 cm, respectively, the largest Youden index was the best diagnostic boundary value for Shamblin type III tumors.ConclusionsCDU combined with CTA and MRA can accurately evaluate the size and classification of CBTs.

The effect of preoperative embolization rate on surgical outcomes for carotid paraganglioma resection.

Preoperative embolization of paragangliomas decreases tumor volume and reduces intraoperative blood loss. This study aimed to evaluate the effect of the rate of devascularization achieved by preoperative embolization of carotid body tumors on surgical outcomes. Patients with carotid body tumors who underwent preoperative transarterial embolization between 2013 and 2024 were included in this retrospective study. The Shamblin classification of all patients was carried out using radiological imaging. Devascularization rates obtained after the embolization of carotid body tumors were determined from angiographic images. Patients were divided into two groups: near-complete embolization (devascularization rate >90%) and incomplete embolization (devascularization rate <90%). Hemoglobin loss was calculated with blood tests before and immediately after surgery. Tumor volume loss was calculated by preoperative radiological tumor volume and postoperative surgical specimen volume. Hemoglobin loss, tumor volume loss, and postoperative complication rates of the two groups were compared. A total of 31 patients with carotid body tumors who underwent surgery were included in the study. Near-complete embolization was achieved in 21 patients (67.74%), while incomplete embolization was achieved in 10 patients (32.25%). Shamblin classification was statistically similar (p>0.05) between the two groups. The vascular complication rate in the near-complete embolization group was significantly lower than in the incomplete embolization group (p=0.027). However, no significant difference was observed in neurological complication rates, hemoglobin loss, and tumor volume loss parameters between the two groups (p>0.05). The preoperative devascularization rate should be at least 90% to minimize the risk of vascular complications.

Risks to predict blood loss and cranial nerve injury in carotid body paraganglioma resection

Objective: To investigate clinical and imaging parameters to predict blood loss and cranial nerve injury (CNI) following carotid body paraganglioma (CBP) resection. Methods: A retrospective examination of clinical and imaging data was conducted on 63 patients who underwent CBP resection at Xiangya Hospital of Central South University from January 2016 to December 2022, including 23 males and 40 females, aged 26-87 years old. Three imaging parameters including tumor volume, the angle of contact with the internal carotid artery (ICA), and the distance to the base of skull (DTBOS) were gauged using the IMEDPACS software on CTA and MR imaging. The predictive efficacies of age, gender, Shamblin classification, and three imaging parameters for blood loss and CNI following surgery were analysed. Logistic composite parameter models were constructed and their predictive validity was assessed. Results: Multivariate logistic regression analysis underscored that only tumor volume (OR=1.381,95%CI:1.167-1.507,P=0.001) showed significant statistical correlations with blood loss following surgery. Area under curve (AUC) values of 0.910 for receiver operating characteristic (ROC) curves showed a sensitivity of 1.000 and a specificity of 0.694. Tumor volume (OR=1.126,95%CI:1.030-1.231, P=0.002) and DTBOS (OR=0.225,95%CI:0.081-0.630,P=0.005) were significantly associated with postoperative CNI. The analysis of logistic composite model showed AUC values for tumor volume, DTBOS and combination of the two parameters were 0.858, 0.788, and 0.872, respectively. The model for combination of tumor volume and DTBOS also proved superior in predicting postoperative CNI (Z=3.106, P<0.001), with a sensitivity of 0.833 and a specificity of 0.769. Conclusions: Tumor volume and DTBOS emerged as effective predictors for blood loss and/or CNI in patients with CBP resection. Moreover, the logistic composite parameter model outclassed single-parameter models in terms of their predictive clinical value.

Cardiovascular surgery perspective on carotid body tumors: Retrospective study

Objectives: In this study, we aimed to share the results of the patients we operated on due to carotid body tumors and our preoperative, perioperative, and postoperative perspective. Patients and Methods: The medical records of patients who underwent surgery due to carotid body tumor between January 2004 and December 2020 were retrospectively reviewed. Seventeen patients (2 male, 15 female; mean age 52.4±15.4 years; range 25 to 75 years) who underwent surgery were evaluated based on age, sex, complaints, Shamblin classification, surgical procedures, and complications. Results: The smallest tumor was 15x15x11 mm, and the largest tumor was 75x55x45 mm. There were five Shamblin I, nine Shamblin II, and three Shamblin III patients. External carotid artery ligation and tumor excision were performed in one patient, while en blok tumor excision was performed in other patients without the need for vascular repair. No complications occurred, except for the ninth and 12th cranial nerve injuries that developed in one patient. Conclusion: Although follow-up and radiotherapy are recommended for high surgical risk, elderly, and comorbid patients, we believe that a careful and rigorous surgery by experienced surgeons, in accordance with the necessary multidisciplinary approach and thorough preoperative assessment, could be safely and effectively performed with low mortality and morbidity for carotid body tumors.

Proteomics analysis of carotid body tumor revealed potential mechanisms and molecular differences among Shamblin classifications.

Carotid body tumors (CBTs) are a rare type of paraganglioma, and surgical resection is the only effective treatment. Because of the proximity of CBTs to the carotid artery, jugular vein, and cranial nerve, surgery is extremely difficult, with high risks of hemorrhage and neurovascular injury. The Shamblin classification is used for CBT clinical evaluation; however, molecular mechanisms underlying classification differences remain unclear. This study aimed to investigate pathogenic mechanisms and molecular differences between CBT types. In Shamblin I, II, and III tumors, differentially expressed proteins (DEPs) were identified using direct data-independent acquisition (DIA). DEPs were validated using immunohistochemistry. Proteomics profiling of three Shamblin subtypes differed significantly. Bioinformatics analysis showed that adrenomedullin signaling, protein kinase A signaling, vascular endothelial growth factor (VEGF) signaling, ephrin receptor signaling, gap junction signaling, interleukin (IL)-1 signaling, actin cytoskeleton signaling, endothelin-1 signaling, angiopoietin signaling, peroxisome proliferator-activated receptor (PPAR) signaling, bone morphogenetic protein (BMP) signaling, hypoxia-inducible factor 1-alpha (HIF-1α) signaling, and IL-6 signaling pathways were significantly enriched. Furthermore, 60 DEPs changed significantly with tumor progression. Immunohistochemistry validated several important DEPs, including aldehyde oxidase 1 (AOX1), mediator complex subunit 22 (MED22), carnitine palmitoyltransferase 1A (CPT1A), and heat shock transcription factor 1 (HSF1). To our knowledge, this is the first application of proteomics quantification in CBT. Our results will deepen the understanding of CBT-related pathogenesis and aid in identifying therapeutic targets for CBT treatment.

Predictors for postoperative cranial nerve complications in carotid body tumor resection: a retrospective cohort study.

Carotid body tumors (CBTs) are slow-growing benign tumors. Therefore, surgical resection is considered in case of tumor growth. The timing of surgery is of the utmost importance as the risk of iatrogenic surgical complications increases when resecting larger tumors, whereas on the other hand, resections for asymptomatic small CBT should be prevented. The primary aim of this study was to identify which tumor size or dimension is most accurate to predict nerve injury in patients undergoing resection of a CBT. This retrospective cohort study included patients who underwent surgical resection of CBT at the university hospital in South-Holland. Baseline patient characteristics and tumor measurements were retrieved from the medical records. The authors assessed how the different methods of measuring the size of the tumor were interrelated using Pearson correlation. Logistic regression was used to assess which variables were independently associated with nerve injury, including age at surgery, Shamblin classification, and those dimensions that captured different aspects of tumor size (rather than measuring the same as shown by high correlations) as possible independent variables. In 125 patients, 143 CBTs were resected whereof in 35 cases cranial nerve injury occurred, (transient in 16 cases and permanent in 19 cases). The risks for nerve injury increased with larger tumor size and the Shamblin classification. Logistic regression analysis showed that the anterior-posterior (AP) diameter significantly increased the odds of a nerve injury, a doubling for every 1cm increase in AP diameter [odds ratio (95% CI) 2.12 (1.29-3.48), P =0.003]. This study shows that measured tumor size in the AP plane is a strong predictor for postoperative nerve injury of a CBT resection. This predictor can be used in the daily clinic to give insight in operative risks. More research is needed in order to select the most appropriate time window for CBT resection.

Preoperative embolization is necessary for large-volume carotid body tumor (≥ 6670mm3) resection.

To investigate the impact of preoperative embolization (p-TAE) on CBT surgical resection and explore the optimal tumor volume for p-TAE of CBT resection. This retrospective study reviewed 139 surgically excised CBTs. According to Shamblin classification, tumor volumes, and whether to carry out the p-TAE, the patients were classified into different groups. The demographic, clinical features, and the intraoperative and post-operative information about the patients were retrieved and analyzed from the patient records. A total of 139 CBTs was excised in 130 patients. According to the results of subgroup analysis, there were no significant differences in surgical time, blood loss, adverse events (AEs), and the revascularization when compared with non-embolization group (NEG) for type I, II, III, respectively (all p > 0.05) except for the surgical time in type I (p < 0.05). Then the X-tile program was employed and determine the cutoff point (tumor volume = 6670mm3) for tumor volumes and blood loss. The average tumor volume was (29,782.37 vs. 31,345.10mm3, p = 0.65) for embolization group (EG) and NEG. The mean surgical time (208.86 vs. 264.67min, p > 0.05) and intraoperative blood loss (252.78 vs. 430.00mL, p < 0.05) were less, and the incidence of revascularization required (35.56 vs. 52.38%, p > 0.05) and total complications (27.78 vs. 57.14%, p < 0.05) were lower in EG when compared with NEG (tumor volume ≥ 6670 mm3). However, the results were not statistically significant when the tumor size was less than 6670mm3. No surgery-related mortality was observed during the follow-up. Preoperative selective embolization of CBT is an effective and safe adjunct for surgical resection, especially for Shamblin class II and III tumors (≥ 6670mm3).

Role of pre-operative embolization in carotid body tumor surgery according to Shamblin classification: A systematic review and meta-analysis.

Pre-operative embolization prior to surgical resection of carotid body tumors was meant to decrease intraoperative blood loss and operative time. Yet, potential confounders such as different Shamblin classes have never been analyzed. Aim of our meta-analysis was to investigate effectiveness of a pre-operative embolization according to different Shamblin classes. Five studies comprising 245 patients were included. A random effects model meta-analysis was conducted, and the I2 statistic was used to assessment for heterogeneity. Pre-operative embolization was associated with a significant reduction in blood loss (WM: 276.4mL; 95% CI, 201.9-378.3, p < 0.01); an absolute mean reduction, though not statistically significant, was observed in both Shamblin 2 and 3 classes. No difference in operative time was found between the two strategies (WM: 192.0min; 95% CI, 157.7-234.1, p=1.0). Embolization proved an overall significant reduction in perioperative bleeding, which did not reach threshold for statistical significance when Shamblin classes were singularly considered.

Association of Complications During and After Carotid Body Tumor Resection with Tumor Size and Distance to the Base of Skull

Depending on the size and location of the tumor, carotid body tumor (CBT) resection can come with various complications, mostly intraoperative bleeding, and cranial nerve injuries. In the present study, we aim to evaluate two fairly new variables, tumor volume, and distance to the base of the skull (DTBOS), with operative complications of carotid body tumor (CBT) resection. Patients who underwent carotid body tumor surgery in Namazi hospital from 2015 to 2019 were studied using standard databases. Tumor characteristics and distance to the base of the skull were measured via computed tomography or Magnetic resonance imaging. Outcomes, including intraoperative bleeding and cranial nerve injuries, along with perioperative data were collected. A total of 42 cases of CBT were evaluated with an average age of 53.21±12.8 and mostly female (85.7%). Based on Shamblin scoring, 2 (4.8%) were classified as group I, 25 (59.5%) as group II, and 15 (35.7%) as group III. The amount of bleeding significantly increased with an increase in the Shamblin scores (P=0.031; median: I: 45cc; II: 250cc, III: 400cc). Also, there was a significant positive correlation between the size of the tumor and the estimated amount of bleeding (Correlation Coefficient = 0.660; P<0.001), and also a significant reverse correlation with between bleeding and DTBOS (Correlation Coefficient= -0.345; P=0.025). During the follow-up of the patients, six (14.3%) had abnormalities in their neurological evaluation. Receiver operating characteristic curve analysis revealed the size of tumor cutoff level 32.7 cm3 (3.2cm radius) to be most predictive of post-op neurological complication with an area under the curve=0.83, sensitivity=83.3%, specificity=80.6%, a negative predictive value= 96.7%, and positive predictive value of 41.7%, and an accuracy of 81.0%. Furthermore, based on the predictive power of the models in our study, we demonstrated that a combination model including the tumor size, DTBOS, along with the Shamblin score had the most predictive power for neurological complications. By evaluating CBT size and distance to the base of the skull, paired with the use of the Shamblin classification, a better, more insightful understanding of possible risks and complications of CBT resection can be obtained, leading to deserved levels of patient care.

MR imaging-based risk stratification scoring system to predict clinical outcomes in carotid body tumors.

This study aims to evaluate the role of pretherapy MRI in predicting outcomes in carotid body tumors and propose a grading system for high- and low-risk characteristics. A retrospective observational study of 44 patients with 51 lesions was carried out from year 2005 to 2020. MR images were reviewed for characteristics of carotid body tumor, and a score was given that was correlated with intra- and postoperative findings. The various other classifications and our proposed Mahajan classification were compared with Shamblin's classification. The area under the curve and ROC curves were used to present the accuracy of different predictive models. Our scoring system allotted a score of 0 to 15 on the basis of MRI characteristics, with scores calculated for patients in our study ranging from 0 to 13. Lesions with scores of 0-6 were considered low risk (45%), and scores of 7-15 were regarded as high risk for surgery (55%). The Mahajan classification stages tumors into four grades: I (10%), II (20%), IIIa (8%), and IIIb (62%). The frequency of vascular injury was 50% in category I and 64% in category IIIb. The frequency of cranial nerve injury was 50%, 66%, and 27% in categories I, II, and IIIb. The Mahajan classification of CBTs evaluates high-risk factors like the distance of the tumor from the skull base and the angle of contact with ICA, which form the major predictors of neurovascular damage and morbidity associated with its surgery. Though the Shamblin classification of CBT is the most widely accepted classification, our proposed Mahajan classification system provides an imaging-based alternative to prognosticate surgical candidates preoperatively.

Preoperative Embolization Of Carotid Body Tumours: Yes Or No?

Carotid body tumours (CBT) are rare paragangliomas for which surgical resection is still the recommended treatment. Frequently they are a benign disorder, discovered as asymptomatic neck masses located at the carotid bifurcation. Preoperative embolization has been used to decrease tumor volume, intraoperative blood loss and nerve injuries.There is however still much controversy and some studies argue that this strategy could increase risks without benefit. This study aimed to investigate the impact of embolization on CBT resection outcomes. Methods: We analyzed all electronic clinical records on consecutive patients treated in the last 10 years (January 2008 - January 2018) in our vascular surgery department. Patients were divided into 2 groups according to treatment: preoperative embolization and subsequent resection (PE) and resection alone (RA). The following variables were reviewed and compared between groups: age, gender, tumor size, surgery duration, days of hospitalization, complications and transfusion needs. Results: Sixteen tumours were treated. Of these, 6 underwent PE and 10 underwent RA. Median follow-up was 54 months (IQR 78). All tumours were benign and no disease recurrence was detected. When compared, PE and RA groups had no differences in Shamblin classification (p=0.068), although tumor's median size was significantly bigger in CBT-PE (49mm v. 35,5mm, p=0,016).The days of hospitalization were significantly higher in the PE group (median 7 vs 3 p=0.012). Concerning surgery time (201min v. 141min, p=0.093), cranial nerve injury (66.7% v. 20%, p=0.092) and need for intraoperative transfusion (16,7% v. 10%, p=0.625), no differences were found. Conclusions: The role of preoperative embolization in CBT has been questioned. In this study we found no benefits supporting embolization prior to surgery.

Microsurgical treatment of carotid body tumors using periadventitial dissection: Analysis of outcomes and prognostic factors in a neurological referral center.

Surgical resection for carotid body tumors (CBTs) is the gold standard of treatment and continues to be a challenging procedure, commonly associated with high vascular injury rates and neurological complications. It is a retrospective case series study between January 2002 and November 2020, with a mean follow-up of 29 months in a single nationwide referral center. Thirty-one patients diagnosed with a carotid body tumor and treated with microsurgical periadventitial resection were included in the study. Patients' demographics, comorbidities, clinical, radiological factors, and tumor grade, evaluated by the Shamblin scale, were obtained. Statistical analysis was performed on all collected data. In this study, we included 31 patients (32 tumors), 80% of the patients were female, and 20% were male, with a mean age of 53 years. One patient presented with bilateral lesions, while 17 tumors were located on the left side. The most frequent symptom was a painless, slow-growing neck mass in 74% of patients. Using the Shamblin classification, 13% of tumors were Grade I, 53% Grade II, and 34% Grade III. In the postoperative period, 3% of patients presented with permanent cranial nerve deficit, while none had vascular injuries or postoperative stroke. A tumor >5 cm increased the risk for nerve lesion by 11 times (OR 12.6, CI 95% 7.4-11.4, P < 0.001). Preoperative embolization followed by periadventitial resection by means of a microsurgical technique is a safe and effective approach to remove CBT, with 3% cranial nerve injury rate and no need for vascular sacrifice or reconstruction.

Clinical Characteristics and Surgical Outcomes of Carotid Body Tumors: Data from the Carotid Paraganglioma Cooperative International Registry (CAPACITY) Group

This study's objective was to conduct a multinational registry of patients with carotid body tumors (CBTs) and to analyze patients' clinical characteristics, treatments, and outcomes. Retrospective study from the Carotid Paraganglioma Cooperative International Registry involving eleven medical centers in Bolivia, Ecuador, Mexico, and Spain, of all patients with a CBT who underwent resection between 2009 and 2019. A total of 1432 patients with a CBT surgically treated were included. Median patient age was 54years (range: 45-63years), and 82.9% (1184) of the study cohort were female. While at low altitude, the proportion of female-to-male cases was 2:1, at high altitude, this proportion increased to 8:1, with statistically significant differences (p = .022). Median operative time was 139min (range: 110-180min), while median operative blood loss was 250ml (range: 100-500ml), with statistically significant difference in increased blood loss (p = .001) and operative time (p = .001) with a higher Shamblin classification. Eight (0.6%) patients suffered stroke. Univariate analysis analyzing for possible factors associated with increased odds of stroke revealed intraoperative vascular lesion to present an OR of 2.37 [CI 95%; 1.19-4.75] (p = 0.001). In 245 (17.1%), a cranial nerve injury was reported. Seven (0.5%) deaths were recorded. The most common CBT type on this cohort was hyperplasic, which might be partially explained by the high altitudes where these patients lived. Increased blood loss and operative time were associated with a higher Shamblin classification, and the risk of stroke was associated with patients presenting transoperative vascular lesions.

AN ANALYSIS OF AN INTEGRATED APPROACH TO CAROTID BODY TUMOR SURGICAL TREATMENT AT THE NATIONAL RESEARCH ONCOLOGY CENTER (NUR-SULTAN, KAZAKHSTAN)

Relevance: Carotid body tumors (CBT) account for 0.01% of all head and neck tumors. 5-15% of CBTs are malignant. The expansive&#x0D; growth of this tumor and its tight attachment to the carotid arteries pose a risk of damage to the main blood vessels and cranial nerves&#x0D; during surgery, which can lead to life-threatening bleeding. Today, preoperative embolization of CBT feeding vessels (PECBT) is used to&#x0D; minimize blood loss during CBT radical excision.&#x0D; The study aimed to evaluate the results of preoperative preparation of patients with CBT by PECBT; justification of a CBT incidence&#x0D; multicenter study to determine CBT’s current status in Kazakhstan.&#x0D; Methods: An anamnesis was collected from all patients, and instrumental diagnostic studies (ultrasound, CTA) were performed. We&#x0D; used the Shamblin (1971) classification of CBT modified by Luna-Ortiz et al. (2006). PECBT was performed to prepare patients for open&#x0D; surgery. CBT excision tactics were selected depending on the classification of the CBT, according to Shamblin.&#x0D; Results: Out of 9 patients with CBT, seven patients complained mainly of a neck tumor; the others mentioned pain and dysphagia. Four&#x0D; patients had a left-side CBT, and the others had a right-side. One tumor was Shamblin type I, five were Shamblin type II, and three were&#x0D; Shamblin type III. Eight patients underwent PECBT, and one was operated on without PECBT. In 8 cases, CBT was surgically incised;&#x0D; one patient did not show up for the second stage of treatment. Arterial reconstruction was required in two cases. First, an average size&#x0D; tumor was 27.4 cm3&#x0D; . The CBT excision was controlled without significant bleeding thanks to the presence of an embolic agent. Blood loss&#x0D; averaged 750 ml; reinfusion – 243.3 ml.&#x0D; Conclusion: The CBT incidence in Kazakhstan has not been studied yet, so a multicenter study is required. Early ultrasound and CT&#x0D; diagnostics support providing patients with up-to-date, efficient surgical treatment. In addition, PECBT provides favorable conditions for&#x0D; tumor resection without hemodynamically significant blood loss

AN ANALYSIS OF AN INTEGRATED APPROACH TO CAROTID BODY TUMOR SURGICAL&#x0D; TREATMENT AT THE NATIONAL RESEARCH ONCOLOGY CENTER&#x0D; (NUR-SULTAN, KAZAKHSTAN)

Relevance: Carotid body tumors (CBT) account for 0.01% of all head and neck tumors. 5-15% of CBTs are malignant. The expansive growth&#x0D; of this tumor and its tight attachment to the carotid arteries pose a risk of damage to the main blood vessels and cranial nerves during surgery&#x0D; that can lead to life-threatening bleeding. Today, preoperative embolization of CBT feeding vessels (PECBT) is used to minimize blood loss during&#x0D; CBT radical excision.&#x0D; The study aimed to evaluate the results of preoperative preparation of patients with CBT by PECBT; justification of a CBT incidence multicenter study to determine CBT's current status in Kazakhstan.&#x0D; Methods: An anamnesis was collected from all patients, and instrumental diagnostic studies (ultrasound, CTA) were performed. We used the&#x0D; Shamblin (1971) classification of CBT modified by Luna-Ortiz et al. (2006). PECBT was performed to prepare patients for open surgery. CBT&#x0D; excision tactics were selected depending on the classification of the CBT according to Shamblin.&#x0D; Results: Out of 9 patients with CBT, seven patients complained mainly of a neck tumor; the others mentioned pain and dysphagia. Four patients had a left-side CBT, and the others had a right-side. One tumor was Shamblin type I, five were Shamblin type II, and three were Shamblin type&#x0D; III. Eight patients underwent PECBT, and one was operated on without PECBT. In 8 cases, CBT was surgically incised; one patient did not show&#x0D; up for the second stage of treatment. Arterial reconstruction was required in two cases. An average size tumor was 27.4 cm3. The CBT excision was&#x0D; controlled without significant bleeding thanks to the presence of an embolic agent. Blood loss averaged 750 ml; reinfusion – 243.3 ml.&#x0D; Conclusion: The CBT incidence in Kazakhstan has not been studied yet, so a multicenter study is required. Early ultrasound and CT diagnostics support providing patients with up-to-date, efficient surgical treatment. PECBT provides favorable conditions for the tumor resection without&#x0D; hemodynamically significant blood loss

Sex differences according to ethnic presentation in carotid body tumors: a systematic literature review

&lt;p&gt;Compare through a systematic literature review, the sex distribution of patients with carotid body tumors in Mexico and Latin America with the rest of the world. The eligibility criteria included retrospective cohort studies of more than 15 patients with a diagnosis of carotid body tumor (regardless of Shamblin's classification or clinical manifestations), which also reported the number of women and men affected, as well as their mean age. We divided the countries where the studies were conducted into regions (Latin America, USA, and Europe/Asia). The sex ratio difference between regions was calculated using a chi-square test. A p&amp;lt;0.05 was considered statistically significant. Thirty-eight studies met the eligibility criteria. Latin America had 1,345 cases, the United States had 808, and Europe/Asia had 672. Mexico had the most cases (1125), followed by the United States. The rest of the countries had less than 30 cases each. We found a statistically significant differences when we compared Latin American countries with the United States and Europe/ Asia (p&amp;lt;0.001). However, the most significant difference was observed when we compared Mexico with the United States, Europe/Asia, and other Latin American countries. When comparing other Latin American countries with Europe/Asia, we found a statistical difference (p=0.01); however, there was no statistical difference (p=0.05) when we compared other Latin American countries with the United States. Mexico has the highest number of reported cases of carotid body tumors in the world. Women account for 90% of cases.&lt;/p&gt;

The PUMCH Classification of Carotid Body Tumor

Carotid body tumor is a rare neoplasm located at the bifurcation of the carotid artery. Surgical excision is the main treatment but carries a high risk of bleeding, nerve injury and vascular injury. Shamblin's classification is based on the relationship between tumor and carotid arteries, which has limitations. Including both the horizontal relationship to carotid arteries and vertical extension of the tumors, PUMCH (Peking union medical college hospital) classification can better predict surgical complications and guide the surgery and thus might help to improve the surgical outcomes of the lesions.