Background:After two decades from its introduction in the lateral skull base paraganglioma surgery, the indications and results of preoperative internal carotid artery stenting should be critically assessed.Materials and Methods:Monocentric retrospective study on 26 patients affected by head and neck paragangliomas (19 tympanojugular paragangliomas, 4 carotid body paragangliomas, 3 vagal paragangliomas) preoperatively treated with internal carotid artery stents between 2008 and 2023. The preoperative findings, the intraoperative complications and the final surgical results were analyzed.Results:The stent complication rate was less than 3.1%. Self-expanding highly flexible intracranial nitinol stents were applied. In all cases, it was possible to completely mobilize the internal carotid artery and perform a vascular dissection of the tumor. Gross total tumor resection was possible in 85% of cases. The median follow up was 7.83 y (SD +/− 3.93 y). No local recurrence was observed.Conclusions:The preoperative vascular stent facilitates tumor dissection from the internal carotid artery without risk of vascular damage, helping the surgeon to achieve surgical radicality. The vascular stent is indicated in the case of revision surgeries, circumferential involvement of the vessel and in cases with non-insufficient intracerebral crossflow. Procedural complications, temporary antiplatelet therapy and delay of surgery are the limitations of the procedure.
背景：颈内动脉术前支架置入术应用于侧颅底副神经节瘤手术已有二十年，其适应症与疗效需进行审慎评估。 材料与方法：本研究为单中心回顾性分析，纳入2008年至2023年间26例接受颈内动脉支架置入术前治疗的头颈部副神经节瘤患者（19例鼓室颈静脉球瘤、4例颈动脉体瘤、3例迷走神经副神经节瘤），对术前影像特征、术中并发症及最终手术结果进行系统性分析。 结果：支架相关并发症发生率低于3.1%。所有病例均采用自膨式高柔顺性颅内镍钛合金支架。全部患者均实现颈内动脉完全游离及肿瘤血管解剖分离，85%的病例达到肉眼全切。中位随访时间7.83年（标准差±3.93年），未观察到局部复发。 结论：术前血管支架置入有助于在无血管损伤风险的前提下实现肿瘤与颈内动脉的分离，为术者达成根治性切除创造条件。该技术适用于再次手术、血管环周受累及颅内交叉血流代偿不足的病例。操作并发症、短期抗血小板治疗及手术延迟是该技术的主要局限性。
The Role of Internal Carotid Artery Stent in the Management of Skull Base Paragangliomas
肿瘤(癌症)患者之家