颈动脉球体瘤的诊断和治疗—附3例报告及文献复习

报告1994－1998年诊治颈动脉球体瘤3例，术前误诊及诊断不明确2例，手术＋放射治疗1例，手术切除2例；临床均治愈。指出诊断应有颈动脉球体瘤三主征和B超三征，即颈部非甲状腺肿块包绕颈动脉并见颈动脉壁局限性增厚，管腔受压变窄；肿物位于颈内外动脉分叉部并可见其大小范围；颈内外动脉间距增宽等临床可以诊断。结合彩超及／或DSA和MRI的诊断更佳。治疗上术前行颈动脉压迫训练或缓慢阻断或术时测颈内动脉残压；麻醉可清醒麻醉或清醒麻后全麻。手术先于颈总动脉下放橡皮带或细导尿管，结扎颈我动脉，术时尽量行肿瘤剥离术。术后应注意脑部并发症等。     

颈动脉体瘤的外科治疗

报告１５例颈动脉体瘤的外科治疗，剥离法切除肿块１０例，肿瘤固着于颈总动脉和颈内动脉７例，其中３例切除肿瘤及其固着的颈动脉，２例未能切除肿瘤，提倡以剥离肿瘤手术为主，对估计剥离肿瘤困难者，术前经颈动脉压迫训练，采用清醒麻醉，可以安全切除肿瘤及固着的颈动脉。     

颈动脉球体瘤的诊断和治疗——附3例报告及文献复习

报告 1994～ 1998年诊治颈动脉球体瘤 3例 ,术前误诊及诊断不明确 2例 ,手术 +放射治疗 1例 ,手术切除 2例 ;临床均治愈。指出诊断应有颈动脉球体瘤三主征和 B超三征 ,即颈部非甲状腺肿块包绕颈动脉并见颈动脉壁局限性增厚 ,管腔受压变窄 ;肿物位于颈内外动脉分叉部并可见其大小范围 ;颈内外动脉间距增宽等临床可以诊断。结合彩超及/或 DSA和 MRI的诊断更佳。治疗上术前行颈动脉压迫训练或缓慢阻断或术时测颈内动脉残压 ;麻醉可清醒麻醉或清醒麻后全麻。手术先于颈总动脉下放橡皮带或细导尿管 ,结扎颈外动脉 ,术时尽量行肿瘤剥离术。术后应注意脑部并发症等。     

颈动脉体瘤的外科治疗

报告１５例颈动脉体瘤的外科治疗，剥离法切除肿块１０例。肿瘤固着于颈总动脉和颈内动脉７例，其中３例切除肿瘤及其固着的颈动脉，２例未能切除肿瘤。提倡以剥离肿瘤手术为主，对估计剥离肿瘤困难者，术前经颈动脉压迫训练，采用清醒麻醉，可以安全切除肿瘤及其固着的颈动脉。     

巨大颈动脉球体瘤手术切除1例并文献复习

目的 分析总结颈动脉球体瘤(carotid body tumor,简称CBT)的诊断及手术治疗方法.方法 分析1例CBT患者的临床资料;对PubMed收录文献进行检索,收集均有临床资料完整报道的文献,进行回顾性分析.结果 患者采用Matas训练方法,用自制颈动脉压迫器训练,压迫左侧颈总动脉训练共60天后在全麻下将瘤体整块切除;术后3个月复查,患者已经恢复正常劳动,无任何颅神经受损与大脑缺血表现.术后随访8个月无复发.结论 CBT的主要治疗手段仍然是外科手术.对于估计术中必需牺牲颈内颈总动脉才能彻底切除肿瘤者,术前建立患侧大脑侧枝循环,直接栓塞颈内颈外动脉与颈总动脉,术中切除包括颈动脉分叉处在内的瘤体,出血量少,术后没有任何颅神经与大脑缺血等并发症,方法简单,安全有效,相对于行血管移植者手术简单可靠,手术时间缩短,有利于进一步推广.     

颈动脉体瘤的个体化序贯治疗应用评价

目的探讨颈动脉体瘤的个体化序贯治疗。方法回顾性分析1999年1月～2009年7月诊治的23例(29侧)颈动脉体瘤患者,其中单侧颈动脉体瘤17例,双侧6例;经确诊后采用术前Matas试验-BOT试验-手术的序贯治疗方式。手术方法包括瘤体剥脱、瘤体与颈外动脉同时切除、颈内动脉切除后颈外动脉与颈内动脉远心端吻合或颈内动脉自体血管重建及颈内动脉单纯结扎。结果患者术前Matas试验结果:能持续按压阻断30 min无特殊不适者1周内17侧、2周内26侧、4周内29侧。其中2例女性患者在通过Matas训练后,于术前行BOT试验检测时出现阳性反应。所有患者颈动脉体瘤11侧肿瘤切除后动脉完好,5侧肿瘤切除同时结扎颈外动脉,6侧肿瘤切除后行颈内动脉破损直接修补,2侧肿瘤行颈外动脉与颈内动脉对端吻合,3侧肿瘤取大隐静脉及1侧取颈外静脉行颈总,颈内动脉搭桥,1侧单纯结扎颈内动脉。术后患者出现局灶性脑梗塞1例,Horner综合征5例,迷走神经麻痹6例,舌下神经麻痹3例,面神经麻痹2例,副神经麻痹1例。采用静脉重建的颈内动脉术后3～6个月复查彩超均见重建血管通畅。结论术前Matas试验-BOT试验-手术的序贯治疗方式能有效促进大脑侧枝循环建立;该序贯治疗对术中颈动脉重建是否需要采用转流手术方式提供准确依据,术中颈动脉破裂后单纯颈动脉修补及颈外动脉与颈内动脉端端吻合均不需要行颈动脉转流;仅行大隐静脉搭桥重建颈内动脉时才需要转流手术。颈动脉体瘤的个体化序贯治疗不仅避免了不转流导致造成脑缺血而产生偏瘫、昏迷等严重并发症,而且减少了盲目使用转流管所带来的血管损伤、血栓形成等风险及相关材料的浪费。     

颈动脉体瘤的诊断与手术治疗

目的：探讨颈动脉体瘤的临床特点、诊断和治疗方法,以利于提高诊断和治疗水平。方法：回顾21例（23侧）颈动脉体瘤患者的临床资料,包括术前检查、手术方法和要点及术后处理。结果：DSA和MRI对颈动脉体瘤的确诊率达100%。17例（19侧）接受手术治疗,其中动脉外膜下分离单纯颈动脉体瘤切除术8侧,肿瘤并颈外动脉节段切除术9侧,颈动脉体瘤和颈总动脉分叉并颈内外动脉节段切除及颈动脉结扎1侧,颈动脉体瘤和颈动脉切除及人工血管重建颈动脉1侧。术后1例患者术前药物治疗未控制的室性心律失常自愈;1例出现声嘶,1周后完全恢复;1例颈动脉切除未重建的患者,术后出现经常性头痛,3个月后逐渐消失;其余患者无明显并发症。结论：DSA和MRI是目前诊断颈动脉体瘤的最佳手段。外科切除是首选的治疗措施,肿瘤和颈总动脉分叉及颈内动脉节段切除后,人工血管重建颈动脉是一种安全、有效的治疗方法。     

恶性颈动脉体瘤临床治疗及病理分析

目的 探讨恶性颈动脉体瘤的临床特征、病理及预后特点,以及诊断和治疗方法.方法 回顾性总结分析天津医科大学附属肿瘤医院1982年2月至2006年6月50年间收治的9例恶性颈动脉体瘤患者的临床及病理资料.9例均行超声检查,再行数字减影血管造影检查4例,磁共振血管造影检查3例.术前动脉压迫锻炼5例,其余4例肿物较小可触及颈动脉走行者未行压迫锻炼.术式均为动脉体瘤及周围组织扩大切除术,3例阻断颈总动脉,其中1例行人工血管颈动脉重建术,2例结扎颈总动脉.结果 术前诊断"颈动脉体瘤"7例,"转移癌"1例,"颈部肿物待查"1例.8例术后出现颅神经功能障碍,声嘶3例次,舌偏4例次,Horner综合征3例次,口角左偏1例次,呛咳1例次;术中出血50～1800 ml,输血800～1600 ml,无输血并发症;结扎颈动脉者无围手术期死亡及偏瘫等.术后临床及病理诊断恶性颈动脉体瘤9例,有包膜2例,无包膜7例.颈淋巴转移伴肺转移1例.术后放疗2例.随访时间6个月至14年,中位随访时间6年.生存6例,其中伴有间断头晕及呛咳2例;2例死亡,1例死于颈部复发,1例死于肺癌;1例失访.结论 恶性颈动脉体瘤临床少见,常侵犯颈动脉及颅神经,诊断应以病理学特点结合邻近组织侵犯及发生淋巴或远处转移为准;应及早选择手术治疗行广泛切除,发生转移或复发者预后较差,以放疗为主的综合治疗可能有效.     

经颅多普勒脑血流检测法评估颈动脉阻断后脑侧支循环代偿能力

目的探讨经颅多普勒(transcranialDop-plertest,TCD)在行肿瘤合并颈动脉切除术术前行颈动脉压迫训练时脑血流动力学改变的临床价值。方法采用TCD为14例拟手术患者经颞窗检测,观察在阻断患侧颈动脉后双侧大脑前动脉(anteriorcerebralartery,ACA)、大脑中动脉(middlecerebralartery,MCA)的血流速度变化和Willis环开放情况。结果通过颈动脉压迫训练,数字减影血管造影术(digitalsubtractionangiography,DSA)和TCD检测发现9例患者(64.3%,9/14)Willis环代偿能力不良,在接受颈动脉压迫训练2～6周后,TCD检测其开放状态和脑侧支循环建立良好,患侧ACA、MCA血流速度基本达到阻断前水平,颈动脉压迫训练后患侧颈动脉阻断时TCD检测:ACA和MCA的平均值与训练前颈动脉阻断时比较差异有显著性(ACA:t=19.278,P<0.05;MCA:t=22.278,P<0.05),符合颈动脉切除术指征。14例随访1年以上未见肿瘤复发,无一例手术死亡或发生脑血管并发症。结论TCD是一种无创伤,重复性好,安全可靠,易被接受的脑血流监测评估手段,对肿瘤合并颈动脉切除术尤为重要。     

颈动脉体瘤2例诊治体会

1　临床资料例 1:患者男 ,36岁。因右上颈部无痛性肿块缓慢生长 1年入院。查体 :右颈动脉三角区 5ｃｍ× 5ｃｍ大小搏动性肿块 ,未闻及血管杂音 ,触压肿块可引起呛咳。右颈总动脉造影 :颈总动脉分叉处微血管团块影 ,结构模糊 ,颈内动脉虹吸部及大脑前、中动脉各分支未见异常。初步诊断 :颈部肿块性质待查 (右颈动脉体瘤 ,神经鞘瘤 )。手术治疗 :术中见肿瘤包绕颈总动脉分叉及颈内、外动脉 ,解离肿瘤失败 ,结扎颈总动脉 ,整块切除肿瘤。术后对侧偏瘫、失语 ,呛咳 ,患侧面瘫、舌瘫。术后 2个月 ,面瘫及舌瘫恢复。术后 1年 ,偏瘫恢复 ,可胜任一…     

Diagnosis and therapy for an extracranial carotid aneurysm

Objective

To describe the diagnostic means and therapy employed in three cases of extracranial carotid aneurysms.

Methods

Retrospective analysis of three cases.

Results

For the diagnosis we obtained real-time pictures of each aneurysm by color Doppler ultrasonography before the angiography. Based on the result of cerebral collateral flow evaluation, ligation of both ends of the aneurysm was performed in one case, embolization of the artery in another, and resection of the aneurysm in the other; vascular reconstruction was not necessary.Although a carotid artery balloon occlusion test must be done before the operation, color Doppler ultrasonography and/or a transcranial color Doppler-guided Matas’ test were performed instead, because these patients needed immediate management.

Conclusion

The diagnostic procedures were very useful to decide what action to take in such urgent cases.     

颈动脉体瘤手术治疗的临床分析

目的:分析23例(25个)颈动脉体瘤患者的临床资料,总结其诊断方法和手术治疗方案,并减少术后并发症。方法:2003~2008年,我科收治23例颈动脉体瘤患者,作彩超CTA以及MRA等无创检查,明确诊断后,全部行手术治疗。结果:无手术死亡;无脑栓塞发生;无肿瘤复发;5例发生术后神经并发症。结论:通过多普勒超声、CTA或MRA检查,在术前明确颈动脉体瘤的血供来源和脑部Willis环的结构是否完整,便于判断术中是否能临时阻断颈动脉,减少创面出血,从而减少术后神经并发症的发生和其他组织的损伤。     

诊治颈动脉体瘤4例体会

报告诊治4例颈动脉体瘤的体会。认为彩色Doppler超声（彩超）检查和颈动脉造影，尤其是数字减影血管造影（DSA）对诊断颈动脉体瘤具有较高的价值。本病的唯一治疗方法是手术；术前应行颈总动脉压迫锻炼，为手术创造条件；术式的选择主要根据术前彩超和DSA结果，以及术中所见肿瘤与颈动脉的关系而定。     

HMPAO-SPECT during carotid artery compression (Matas test) in the evaluation of cervical tumor surgery with potential carotid involvement

For planning the surgical approach in patients with head and neck tumours and extensive cervical metastasis the evaluation of possible vascular involvement is necessary. If the carotid artery is suspected to be infiltrated by the tumour masses its resection or plastic substitute becomes sometimes inevitable. For evaluation of the collateral brain perfusion before a possibly necessary carotid resection we examined 10 patients with neck tumours performing the Matas-Test combined with HMPAO Single-Photon-Emission-Computed-Tomography. During ultrasound-controlled manual compression of the involved common carotid artery 99mTc-labelled HMPAO was injected. The SPECT demonstrated the brain perfusion during the carotid compression time period. 6 patients showed a decreased perfusion of the affected hemisphere with - as far as obtained - normal baseline SPECT-results and balloon occlusion tests. 2 of these patients underwent a carotid artery resection, one of the common carotid artery and one of the internal carotid artery. One patient had a significant perfusion deficit in the SPECT but no pathologic findings in angiography and balloon occlusion test. He suffered from hemiparesis postoperatively. The other patient showed preoperatively a minor decrease in perfusion and had no neurological defects postoperatively. Our findings show that the Matas-Test combined with HMPAO-SPECT is a valuable tool for the preoperative evaluation of the collateral brain perfusion. This technique is not invasive and can be performed in every nuclear medicine department with an ECT camera. The HMPAO-SPECT during carotid compression can add useful information or even replace angiography and the balloon occlusion test.     

Congenital absence or hypoplasia of the carotid artery: radioclinical issues

PURPOSE: Congenital anomaly of the carotid artery is a rare abnormality. It is usually discovered incidentally by color Doppler carotid sonography, angiography, computed tomography (CT), or magnetic resonance imaging (MRI) of the head and neck taken for some other reason. Most patients are not symptomatic because of sufficient cerebral circulation supplied to the defective area by the communicating arteries of the circle of Willis, intercavernous anastomosis, communicating arteries from external carotid artery, and by persistent embryologic arteries to the carotid artery territory. However, sometimes, this anatomic variation may eventually lead to some clinical signs and symptoms in particular circumstances in the head and neck of which surgeons are unaware. A retrospective study was designed to emphasize the characteristic radiologic and clinical picture in patients with the congenital absence (agenesis and aplasia) or hypoplasia of the carotid artery, to delineate the associated abnormalities and existing collateral vessels, and to find out its incidence. MATERIAL AND METHODS: Five thousand one hundred cerebral MRI and/or catheter angiograms performed between February 1988 and March 2002 were reviewed for carotid artery abnormality. RESULTS: Seven patients with congenital absence or hypoplasia (4 of these patients were presented with hypoplasia of internal carotid artery [ICA], 3 with absence of ICA) of ICA were identified (0.13%). The radiologic and clinical study of 5 patients with unilateral (3 of these patients were presented with hypoplasia and 2 with absence of ICA) and 2 patients with bilateral (1 was presented with absence of ICA, whereas the other was hypoplasia) congenital abnormality with absence or hypoplasia of ICA demonstrate that those patients are usually asymptomatic and they are diagnosed incidentally. CONCLUSION: It has been concluded that the combined use of magnetic resonance angiography and CT scanning of the skull base may disclose small but patent ICA. Collateral vessels seem to be usual in such cases, but they may be prominent in cases of acquired vascular occlusion, or increased hemodynamic pressure in dysplastic changes in collateral arteries are known causes of aneurysms. The main vascular supply for the brain in patients with congenitally small (hypoplasia) or absent (agenesis or aplasia) ICA is the vertebrobasilar system in bilateral cases. However, contralateral carotid vessel is the dominant arterial supply for unilateral cases, which has to be borne in mind in surgical interventions to the involved side.     

颈动脉体瘤的超声影像学特征研究

目的阐述颈动脉体瘤的超声影像学特征,以及明确术前超声诊断的应用价值。方法本研究包括60例颈动脉体瘤,共65个病灶。应用灰阶超声及多普勒超声研究肿块特征：位置、大小、边界、形状、内部回声与颈动脉系统位置关系,以及瘤体内部和颈动脉系的血流及频谱情况。结果所有瘤体均位于颈总动脉分叉处,肿块呈边界清晰的不均质低回声,61个瘤体内部动、静脉血流丰富,频谱形态呈高速低阻型。结论颈动脉体瘤的声像图表现具有一定特异性,多普勒超声可提供瘤体与颈动脉血管的关系以及瘤体内部血流情况,在颈动脉体瘤的诊断与鉴别诊断中具有重要价值。     

A multidisciplinary approach to carotid body tumors. Report of five cases

We performed a retrospective review of five patients with carotid body tumors at our institution between 1997 and 2005. Out of the five patients, three patients were treated by surgical resection of the tumor, and 2 patients were observed. It would seem that it is difficult to suspect this disease based only on the clinical findings, because the disease was suspected in only one patient at the first medical examination. Imaging tests are important for establishment of the diagnosis. Color Doppler sonography and MR angiography in addition to MRI are useful. Angiography and balloon Matas test are important for selection of candidates for the operation. The resected tumors were all classified in Shamblin's group II. Delayed cerebral infarction was caused in one patient postoperatively, although the carotid artery was preserved. The dissection in a tumor-adventitial plane using the bipolar coagulation technique under the microscope was performed in the other two cases. Histological examination of the specimen revealed no tumor cells in the excision stump. Dissection in the tumor-adventitial plane using bipolar coagulation under the microscope is important for carotid artery preservation and radical resection of Shamblin's group I and II tumors. It is necessary to compare the risk of the operation with the problems of observation in the process of decision making and to achieve reliable informed consent. Moreover, it is necessary to examine the indications for operation in individual cases referring to the age, past history, expected Shamblin's classification, and result of the balloon Matas test. A multidisciplinary approach should be used, involving the fields of otolaryngology, radiology, neurosurgery and vascular surgery to treat these patients.     

Common carotid artery pseudoaneurysm after neck dissection: colour Doppler ultrasound and multidetector computed tomography findings

Common carotid artery pseudoaneurysm is a rare disease, which has been previously unreported in association with neck dissection. We describe the Doppler ultrasound and multidetector computed tomography (CT) findings of a case of carotid pseudoaneurysm, one month after pharyngolaryngectomy with bilateral neck dissection. Multidetector CT confirmed the diagnosis made on the basis of Doppler ultrasound; the high image quality of axial and three-dimensional reconstructions avoided the need for pre-operative conventional angiography. In the presence of a pulsatile cervical mass after neck surgery, pseudoaneurysm of the carotid artery should be included in the differential diagnosis, and multidetector CT can be the sole pre-operative diagnostic imaging modality.     

Evaluation of paragangliomas presenting as a cervical mass on color-coded Doppler sonography.

OBJECTIVES: To assess the potential of color Doppler sonography to identify cervical mass lesions as paragangliomas. STUDY DESIGN: Prospective evaluation. METHODS: Fifteen patients with 18 paragangliomas (13 carotid body tumors, 3 vagal and 2 temporal) presenting as a mass in the neck were investigated using color Doppler sonography. RESULTS: All paragangliomas presented in B-mode sonography as solid, well-defined, and hypoechoic tumors. Color Doppler imaging revealed hypervascularity in 15 (82%) tumors. No flow signal was detected in 3 carotid body tumors at standard velocity encoding (30 cm/s). Only carotid body tumors could be assessed in their full extent. Temporal and vagal paragangliomas were only partially visible. Carotid body tumors showed a splaying of the carotid bifurcation with displacement of the external carotid anteriorly and both the internal carotid and the internal jugular vein posteriorly. Anterior displacement of both carotid arteries and posterior displacement of the internal jugular vein was found in the 3 vagal paragangliomas. The caudal tumor extension of the 2 temporal paragangliomas was recognized within the expanded lumen of the internal jugular vein. According to the direction of tumor growth and vascular supply, the intratumoral flow signal was predominantly directed upward in carotid body tumors and downward in vagal and temporal paragangliomas. CONCLUSIONS: Based on the appearance in the B-mode, the hypervascularity, the relationship toward the carotid arteries and the internal jugular vein, and the intratumoral flow direction, color Doppler sonography was able to establish the diagnosis and type of a paraganglioma.