Pitfalls in Imaging: Differentiating Intravagal and Carotid Body Paragangliomas

2005 ◽  
Vol 84 (6) ◽  
pp. 348-350 ◽  
Author(s):  
Julie Thorp Kerr ◽  
Vincent D. Eusterman ◽  
Stephen M. Yoest ◽  
Charles A. Andersen
Keyword(s):  
Carotid Body ◽  
Carotid Arteries ◽  
Three Dimensional ◽  
Carotid Bifurcation ◽  
Preoperative Imaging ◽  
External Carotid ◽  
Imaging Features ◽  
Gadolinium Contrast ◽  
Surgical Preparation ◽  
Variable Presentation

We report a case of an intravagal paraganglioma and a case of a carotid body tumor to illustrate a variable presentation of the former in which it mimicked the latter on preoperative imaging. The atypical imaging features of the intravagal paraganglioma included inferior extension to the level of the carotid bifurcation and splaying of the internal and external carotid arteries, features that are similar to those seen in a case of carotid body paraganglioma. Proper differentiation of these lesions permits more appropriate preoperative counseling and surgical preparation. When using magnetic resonance angiography rather than catheter angiography, we advocate the inclusion of gadolinium contrast and three-dimensional time-of-flight techniques to better demonstrate the position of the tumor relative to the carotid bifurcation.

scholarly journals Variations in the Branching Pattern of External Carotid Artery in South Kerala Population – A Cadaveric Study

2021 ◽  
Vol 8 (22) ◽  
pp. 1780-1785
Author(s):  
Manju Sudhakaran ◽  
Mini Alikunju ◽  
Vandana Latha Raveendran ◽  
Umesan Kannanvilakom Govindapillai
Keyword(s):  
Carotid Artery ◽  
Head And Neck ◽  
Carotid Arteries ◽  
Carotid Bifurcation ◽  
External Carotid Artery ◽  
External Carotid ◽  
Superior Thyroid Artery ◽  
South Indian Population ◽  
Branching Pattern ◽  
South Indian

BACKGROUND External carotid arteries account for a major share of arterial supply of head and neck regions. As variations are frequently observed in the branching pattern of external carotid artery, surgeons, radiologists and anaesthetists often encounter difficulties in various procedures of head and neck. The purpose of this study is to describe the variations in the branching pattern of external carotid artery as observed in South Indian population which definitely reduces its iatrogenic injuries associated with surgical and radiological procedures of head and neck. METHODS This is cross-sectional descriptive study. Bilateral neck dissection was done on twenty-two formalin fixed cadavers to study the branching pattern of external carotid artery during a period of two years in the Department of Anatomy in Government Medical College, Alappuzha. Common carotid, external carotid and internal carotid arteries were dissected. All the branches of external carotid artery were traced and the variations were noted. The distance between carotid bifurcation and point of origin of individual branches of external carotid were measured and statistically analyzed. RESULTS In the present study along with normal branching pattern of external carotid artery, variations like origin of superior thyroid artery from common carotid artery and also from carotid bifurcation were seen. A common linguofacial trunk and direct origin of superior laryngeal artery from external carotid artery were also observed. CONCLUSIONS Prior knowledge of the variations will be helpful to surgeons and anaesthetists while dealing with these vessels during procedures of head and neck regions. KEYWORDS External Carotid Artery, Carotid Bifurcation, Superior Thyroid Artery, Linguofacial Trunk

Lateral Congenital Anomalies of the Pharyngeal Apparatus: Part III. Cadaveric Representation of the Course of Second and Third Cleft and Pouch Fistulas

2011 ◽  
Vol 77 (9) ◽  
pp. 1257-1263 ◽  
Author(s):  
Petros Mirilas
Keyword(s):  
Hypoglossal Nerve ◽  
Thyroid Cartilage ◽  
Three Dimensional ◽  
Superior Laryngeal Nerve ◽  
Carotid Bifurcation ◽  
Preoperative Imaging ◽  
Digastric Muscle ◽  
Pharyngeal Apparatus ◽  
Human Cadavers ◽  
Anterior Belly

“Stepladder” surgery for fistula from second or third pharyngeal cleft and pouch is “blind.” Neither intraoperative methylene blue injection and probing nor preoperative imaging (fistulo-gram ultrasound, computed tomography, magnetic resonance imaging) reveal three-dimensional anatomic relations of fistulas. This article describes the most common second and third fistula courses and demonstrates representation of their tracts with wires in human cadavers. A second cleft and pouch fistula, at its external opening, pierces superficial cervical fascia (and platysma), then investing cervical fascia, and travels under the sternocleidomastoid muscle, superficial to the sternohyoid and anterior belly of omohyoid. It ascends along the carotid sheath, and at the upper border of the thyroid cartilage it pierces the pretracheal fascia. Characteristically, it courses between the carotid bifurcation and over the hypoglossal nerve. After passing beneath the posterior belly of the digastric muscle and the stylohyoid, it hooks around both glossopharyngeal nerve and stylopharyngeus muscle. The fistula reaches the pharynx below the superior constrictor muscle. The course of a third cleft and pouch fistula is similar until it has pierced pretracheal fascia; then it passes over the hypoglossal nerve and behind the internal carotid, finally descending parallel to the superior laryngeal nerve, reaching the thyrohyoid membrane cranial to the nerve.

scholarly journals In vivo three-dimensional blood velocity profile shapes in the human common, internal, and external carotid arteries

2011 ◽  
Vol 54 (4) ◽  
pp. 1011-1020 ◽  
Author(s):  
Alexey V. Kamenskiy ◽  
Yuris A. Dzenis ◽  
Jason N. MacTaggart ◽  
Anastasia S. Desyatova ◽  
Iraklis I. Pipinos
Keyword(s):  
Velocity Profile ◽  
Carotid Arteries ◽  
Three Dimensional ◽  
Blood Velocity ◽  
External Carotid

Do preoperative imaging features predict surgical complications of carotid body tumors?

2014 ◽  
Vol 219 (4) ◽  
pp. e11
Author(s):  
David Straughan ◽  
Vladimir K. Neychev ◽  
Samira M. Sadowski ◽  
Ryan J. Ellis ◽  
Nicholas Patronas ◽  
...  
Keyword(s):  
Carotid Body ◽  
Surgical Complications ◽  
Preoperative Imaging ◽  
Imaging Features ◽  
Carotid Body Tumors

Relation between histological age-changes in the carotid body and atherosclerosis in the carotid arteries

1987 ◽  
Vol 101 (12) ◽  
pp. 1271-1275 ◽  
Author(s):  
Patrick Lowe ◽  
Donald Heath ◽  
Paul Smith
Keyword(s):  
Blood Flow ◽  
Carotid Body ◽  
Carotid Arteries ◽  
Carotid Sinus ◽  
Carotid Bifurcation ◽  
Age Changes ◽  
Histological Changes ◽  
Atherosclerotic Lesions ◽  
Flow Through ◽  
Human Carotid

Abstract Histological changes in the human carotid body associated with increasing age are accompanied by occlusive atherosclerotic lesions in the arteries of the carotid bifurcation, and are probably ischaemic in origin. The carotid sinus, however, is unusually susceptible to the development of atheroma and its occlusion appears to have little influence in compromising blood flow through the glomic arteries.

Diagnosis and Treatment of Carotid Body Tumors

1978 ◽  
Vol 87 (5) ◽  
pp. 614-621 ◽  
Author(s):  
Paul H. Ward ◽  
Herman A. Jenkins ◽  
William N. Hanafee
Keyword(s):  
Carotid Body ◽  
Arterial Wall ◽  
Carotid Arteries ◽  
External Carotid ◽  
Graft Replacement ◽  
Arterial Anastomosis ◽  
Feeding Vessels ◽  
Carotid Body Tumors ◽  
Carotid Bulb ◽  
The Common

The diagnosis and management of carotid body tumors are discussed, including the importance of good arteriography which allows visualization of all major feeding vessels. These include the carotid bulb, internal and external carotid arteries and the often neglected but important vertebral and ascending cervical arteries. Emphasis is placed on the importance of establishing tourniquet control of the common, internal and external carotid arteries. Surgeons removing carotid body tumors should be experienced in arterial wall repair by means of vascular shunts, end-to-end arterial anastomosis, and vein graft replacement of a segment of arterial wall.

scholarly journals Variations, relations and clinical significance of carotid arterial system in anterior neck: a cadaveric study

2019 ◽  
Vol 7 (4) ◽  
pp. 1127
Author(s):  
Anasuya Ghosh ◽  
Subhramoy Chaudhury ◽  
Atin Datta
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Hypoglossal Nerve ◽  
Carotid Bifurcation ◽  
External Carotid Artery ◽  
Arterial System ◽  
External Carotid ◽  
The Common ◽  
Carotid Arterial

Background: The common carotid, internal and external carotid arteries and their branches serve as major source of blood supply in head-neck region of human and are often encountered during numerous surgical and clinical interventions of neck.Methods: We dissected and examined both sides of neck in 49 well embalmed cadavers (98 sides). We recorded the following anatomical parameters of carotid arterial system-level of bifurcation, the relation between internal and external carotid arteries, branching pattern of anterior branches of external carotid artery, tortuosity in carotid arterial system, and relation of hypoglossal nerve with the carotid arteries.Results: In 56.16 % cases, the common carotid arterial bifurcation took place at the upper border of thyroid cartilage though high bifurcation was quite common (43.88%). The external carotid artery was located antero-medial to internal carotid artery in most cases (93.87%). Abnormal tortuosity of carotid arterial system was detected in 2.04% cases only. In 86.73% cases, the hypoglossal nerve crossed the internal and external carotid artery superior to carotid bifurcation above the level of hyoid bone while in 1 case it crossed immediately inferior to carotid bifurcation. In branching pattern, following variations were observed- linguo-facial trunk in 15.3% cases, thyro-lingual trunk in 5.1% cases, origin of superior thyroid artery from common carotid in 10.02% cases and origin of superior thyroid from internal carotid in one case (1.02%).Conclusions: The carotid arterial system has complex and variable anatomy in neck and this information should be kept in mind to avoid unwanted damage during surgical procedures of neck.

Three-Dimensional Color Doppler Transpharyngeal Echocardiographic Reconstruction of the Left Common, Internal, and External Carotid Arteries

2002 ◽  
Vol 19 (3) ◽  
pp. 223-225 ◽  
Author(s):  
Andrew P. Miller ◽  
Srinivasa R. Aaluri ◽  
Osman M. Mukhtar ◽  
Navin C. Nanda
Keyword(s):  
Carotid Arteries ◽  
Color Doppler ◽  
Three Dimensional ◽  
External Carotid

scholarly journals Automated segmentation of the individual branches of the carotid arteries in contrast-enhanced MR angiography using DeepMedic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Magnus Ziegler ◽  
Jesper Alfraeus ◽  
Mariana Bustamante ◽  
Elin Good ◽  
Jan Engvall ◽  
...  
Keyword(s):  
Mr Angiography ◽  
Carotid Arteries ◽  
Ground Truth ◽  
Carotid Bifurcation ◽  
External Carotid ◽  
Dice Similarity Coefficient ◽  
Segmentation Method ◽  
Positive Ratio ◽  
Contrast Enhanced ◽  
The Individual

Abstract Background Non-invasive imaging is of interest for tracking the progression of atherosclerosis in the carotid bifurcation, and segmenting this region into its constituent branch arteries is necessary for analyses. The purpose of this study was to validate and demonstrate a method for segmenting the carotid bifurcation into the common, internal, and external carotid arteries (CCA, ICA, ECA) in contrast-enhanced MR angiography (CE-MRA) data. Methods A segmentation pipeline utilizing a convolutional neural network (DeepMedic) was tailored and trained for multi-class segmentation of the carotid arteries in CE-MRA data from the Swedish CardioPulmonsary bioImage Study (SCAPIS). Segmentation quality was quantitatively assessed using the Dice similarity coefficient (DSC), Matthews Correlation Coefficient (MCC), F2, F0.5, and True Positive Ratio (TPR). Segmentations were also assessed qualitatively, by three observers using visual inspection. Finally, geometric descriptions of the carotid bifurcations were generated for each subject to demonstrate the utility of the proposed segmentation method. Results Branch-level segmentations scored DSC = 0.80 ± 0.13, MCC = 0.80 ± 0.12, F2 = 0.82 ± 0.14, F0.5 = 0.78 ± 0.13, and TPR = 0.84 ± 0.16, on average in a testing cohort of 46 carotid bifurcations. Qualitatively, 61% of segmentations were judged to be usable for analyses without adjustments in a cohort of 336 carotid bifurcations without ground-truth. Carotid artery geometry showed wide variation within the whole cohort, with CCA diameter 8.6 ± 1.1 mm, ICA 7.5 ± 1.4 mm, ECA 5.7 ± 1.0 mm and bifurcation angle 41 ± 21°. Conclusion The proposed segmentation method automatically generates branch-level segmentations of the carotid arteries that are suitable for use in further analyses and help enable large-cohort investigations.

scholarly journals Paradigm Shift of Carotid Body Paraganglioma Surgical Technique from Caudocranial to Craniocaudal Dissection: Analysis of Recent Literature

2014 ◽  
Vol 5 (3) ◽  
pp. 119-125
Author(s):  
Sudhir Naik ◽  
Rajshekar Halkud ◽  
A Nanjundappa ◽  
Siddharth Biswas ◽  
Ashok M Shenoy ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Technique ◽  
Carotid Artery ◽  
Carotid Body ◽  
Computed Tomography Angiography ◽  
Paradigm Shift ◽  
Recent Literature ◽  
Preoperative Assessment ◽  
Preoperative Imaging ◽  
External Carotid

ABSTRACT Background The classical Shamblin's classification predicts only vascular morbidity without remarking on the neurological morbidity, while the neurological damage increase with vessel ligation and reconstruction. A modified Shamblin's classification described by Luna-ortiz with incorporation of the Hallett's zones of injury has been studied here. Materials and methods We present a case series analysis of carotid body paraganglioma managed in our institute. The study included 17 patients, 14 females and three males with a mean duration of presentation of 6.82 months. All were imaged with multislicer computed tomography angiography (CTA) and magnetic resonance angiography (MRA) for preoperative assessment and operated in the craniocaudal technique. The tumors were graded according to the modified Shamblin's criteria: grades I (2), II (13), IIIa (2), IIIb (0). Results All the preoperative assessment of grading matched with the intraoperative findings. External carotid artery (ECA) ligation was done in two cases, no internal carotid artery (ICA) ligation and reconstruction were done. Two cases of permanent damage to the 12th nerve, two vagal nerve weakness was seen. No stroke or mortality recorded. The tumor was confirmed on immunohistochemistry. The patients were followed up for 6 months to 5 years with a mean follow-up of 2.5 years. Conclusion Preoperative imaging assessment using multislicer computed tomography angiography (MSCTA) and MRA helps to measuring the circumferential vessel involvement in grade III tumors. So, a craniocaudal dissection with assessment of all the zones of injury reduced blood loss and minimized neurovascular complications. How to cite this article Halkud R, Shenoy AM, Nanjundappa A, Chavan P, Sidappa KT, Madhu SD, Biswas S, Naik SM. Paradigm Shift of Carotid Body Paraganglioma Surgical Technique from Caudocranial to Craniocaudal Dissection: Analysis of Recent Literature. Int J Head Neck Surg 2014;5(3):119-125.

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