Hybrid prosthesis for vascular reconstruction of the internal carotid artery near the skull base after radical excision of a very raremalignant glomus caroticum paraganglioma

摘要

BackgroundNeck tumors are challenging regarding the diagnostic and therapeutic management particularly in cases of malignant growth near relevant vessels to achieve R0 resection status and the best prognosis.AimThe aim of this case report on apatient with arare malignant tumor of the glomus caroticum (paraganglioma) is to present the successful outcome of ademanding interdisciplinary surgical approach (otorhinolaryngology and vascular surgery). Surgical re-intervention was necessary due to malignant tumor growth (detected in the histopathological investigation of the first specimen) including vascular resection using ahybrid graft for vascular reconstruction of the internal carotid artery near the skull base.Case reportA38-year-old male patient underwent magnetic resonance angiography and digital subtraction angiography to clarify the diagnosis of atumor in the right neck. This was preoperatively embolized and subsequently resected including vascular reconstruction using aprosthetic interposition graft (7cm; W.L.Gore, Putzbrunn, Germany) between the common and internal carotid arteries. Histology: malignant paraganglioma 40mm in diameter with haemangiosis et lymphangiosis carcinomatosa demonstrating lymph node metastasis and prompting re-operation (neck dissection levelsII, III, IV, V). This was followed by a novel vascular reconstruction using a GORE (R) hybrid vascular graft prosthetic stent (W.L.Gore) as interposition graft because of the short extracranial stump of the distal internal carotid artery near the skull base and to limit clamping time. Early postoperative outcome revealed no complications and after 24months there were no signs or symptoms of recurrent tumor growth.ConclusionExtended resections, if necessary including vascular (arterial) segments, aim at achieving R0 classification as shown in this extremely rare and usually challenging malignant tumor. Hybrid vascular prostheses are suitable for time-saving vascular reconstruction (>50%) to provide sufficient blood supply.