Preoperative Embolization And Intraoperative Nerve Monitoring In Carotid Body Tumor Resection Are Associated With Worse Outcomes
Robin B. Osofsky, MD, Ross Clark, MD, Jaideep Das Gupta, MD, LeAnn A. Chavez, MD, Sundeep Guliani, MD, Mark Langsfeld, MD, John Marek, MD, Muhammad A. Rana, MD.
University of New Mexico, Albuquerque, NM, USA.
OBJECTIVES: To evaluate the effects of preoperative embolization and intraoperative nerve monitoring on the outcomes following elective resection of carotid body tumors (CBTs).
METHODS: We performed a single center retrospective review of all consecutive patients who underwent CBT resection from 2001 to 2019. Outcomes were compared between CBTs that underwent preoperative embolization versus CBTs without preoperative embolization. Additionally, outcomes were compared for CBTs where intraoperative nerve monitoring (IONM) was utilized with the Nerve Integrity Monitoring System (NIMS) endotracheal tube versus those treated with conventional endotracheal tube.
RESULTS: A total of 46 patients (6 male, 40 female, mean age 50±15 years) underwent resection of 49 CBTs. CBT laterality was 15 (33%) right, 25 (54%) left, and 6 (13%) bilateral. Preoperative imaging modalities utilized were CT angiogram (86%), ultrasound (53%), MRI (37%), and radionucleotide scan (8%) with a mean CBT size of 4.5±1.06 cm. In those with large (≥3 cm) tumors (n=35), preoperative embolization was performed in 51% of cases (n=18) and was associated with increased operative time (OT) (351 vs. 201 mins, P=0.013), incidence of overall complications (56% vs. 18%, P=0.035), and overall cranial nerve injury (56% vs. 18%, P=0.035). No difference was observed in mean estimated blood loss (244 vs. 342 mL, P=0.354), need for internal carotid artery reconstruction (17% vs. 0%, P=0.229) or the incidence of permanent cranial nerve injury (17% vs. 12%, P>0.99). IONM was utilized in 39% of cases (n=18) compared to conventional endotracheal tube in 61% (n=26). IONM was associated with increased OT (372 vs. 182 mins, P<0.001), length of stay (3.8 vs. 2.2 days, P=0.043) and overall cranial nerve injury (39% vs. 8%, P=0.021). A trend toward an increased incidence of overall complications was observed (44% vs. 19%, P=0.098) while no difference in permanent cranial nerve was noted (11% vs. 4%, P=0.558).
CONCLUSIONS: The utility of preoperative embolization and intraoperative nerve monitoring should be called into question as these modalities appear to be paradoxically associated with a significant increase in operative time, incidence of complications and cranial nerve injury after controlling for tumor size.
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