Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Ten-year experience in surgical treatment of carotid paragangliomas

Authors: Darvish N.A., Vasilkov A.S., Eseneev M.F., Shogenov M.A., Ivashchenko V.E., Valieva R.R., Svetlova N.Yu., Zavalikhina T.V.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2025-22-4-346-358

UDC: 616-006.488-089

Link: Clinical Physiology of Blood Circulaiton. 2025; 22 (4): 346-358

Quote as: Darvish N.A., Vasilkov A.S., Eseneev M.F., Shogenov M.A., Ivashchenko V.E., Valieva R.R., Svetlova N.Yu., Zavalikhina T.V. Ten-year experience in surgical treatment of carotid paragangliomas. Clinical Physiology of Сirculation. 2025; 22 (4): 346–285 (in Russ.). DOI: 10.24022/1814-6910-2025-22-4-346-285

Received / Accepted:  20.10.2025 / 17.11.2025

Download
Full text:  

Abstract

Objective. To analyze the in-hospital and long-term results of surgical treatment of carotid paragangliomas over a ten- year period and summarize the department’s experience in preventing carotid artery prosthetic reconstruction and other adverse intraoperative events.

Study design – a single-center retrospective observational study.

Material and methods. Between 2015 and 2024, 18 patients with carotid paragangliomas underwent 19 surgical procedures at the Cardiovascular Surgery Department No. 6 of Bakoulev National Medical Research Center for Cardiovascular Surgery. The mean age of the patients was 62.8 ± 13.9 years (median 67; range 12–75); the gender distribution was equal.

According to the Shamblin classification, 4 patients (21%) had type I tumors, 12 (63%) – type II, and 3 (16%) – type III. Preoperative assessment included duplex ultrasonography of the brachiocephalic arteries, contrast-enhanced Multidetector CT angiography, and conventional digital subtraction angiography.

All patients underwent a longitudinal incision along the anterior border of the sternocleidomastoid muscle, followed by craniocaudal tumor mobilization with mandatory control of carotid artery segments not involved in the tumor process.

In 8 (42.1%) cases, the tumor was resected without manipulation of the carotid arteries; in 6 (31.6%) cases, arterial reconstruction was required; in 3 (15.8%) cases, a segment of the internal carotid artery was resected and an additional distal anastomosis performed; in 2 (10.5%) cases, carotid endarterectomy accompanied tumor resection. The Department’s consistent principle is the preservation of native vessels without prosthetic replacement.

Results. There was no in-hospital mortality. The median blood loss was 200 mL (range 100–1700), and the median operative time was 145 min (range 60–340). Postoperative cranial nerve pareses occurred in 57.9% of patients: tongue deviation – 3 cases, dysphagia – 3, mouth corner ptosis – 2, eyelid ptosis – 1, dysphonia – 10 cases. Ischemic cerebrovascular complications were observed in 1 case (5.3%) as a transient ischemic attack.

The mean blood loss was minimal in Shamblin type I tumors (100 mL), moderate in type II (492 mL), and highest in type III (1067 mL). Cranial nerve paresis occurred in 50% of type I and II cases and in 100% of type III cases.

During follow-up, overall mortality was 1 case (6%), unrelated to surgery, and 1 patient (6%) developed tumor recurrence 9 months after surgery. According to ultrasound follow-up, reconstructed carotid segments remained patent in all patients. Histomorphology examination revealed typical alveolar paragangliomas in most cases; in 10.5%, features of malignancy were detected, requiring further oncological supervision.

Conclusion. The Shamblin classification remains the key factor determining operative complexity and risk of intra- operative complications. The use of a craniocaudal dissection technique, meticulous vascular control, and avoidance of prosthetic grafting enable effective and radical tumor removal without perioperative mortality and contribute to favorable long-term outcomes.

References

  1. Valero C., Ganly I., Shah J.P. Head and neck paragangliomas: 30-year experience. Head Neck. 2020; 42 (9): 2486–2495. DOI: 10.1002/ hed.26277
  2. Graham N.J., Smith J.D., Else T., Basura G.J. Paragangliomas of the head and neck: a contemporary review. Endocr. Oncol. 2022; 2: R153– R162. DOI: 10.1530/EO-22-0080
  3. Palade D.O., Hainarosie R., Zamfir A., Vrinceanu D., Pertea M., Tusaliu M. et al. Paragangliomas of the head and neck: a review of the latest diagnostic and treatment methods. Medicina (B Aires). 2024; 60: 914. DOI: 10.3390/medicina60060914
  4. Голухова Е.З. Отчет о лечебной и научной работе Национального медицинского исследовательского центра сердечно-сосудистой хирургии им. А.Н. Бакулева Минздрава России за 2024 год. Перспективы дальнейшего развития. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2025; 26 (спецвыпуск): 5–130. DOI: 10.24022/1810-0694-2025-26S
  5. Harley R.J., Lee J.H., Ostrander B.T., Finegersh A., Pham T.B., Tawfik K.O. et al. Local tumor behavior associated with survival among patients with paraganglioma of the head and neck. OTO Open. 2022; 6. DOI: 10.1177/2473974X221086872
  6. Шубин А.А. Ангиохирургические аспекты лечения хемодектом шеи. Дис. … д-ра мед. наук. М.; 2003.
  7. Аракелян В.С., Газимагомедов З.И., Абдулгасанов Р.А. Диагностика и результаты хирургического лечения каротидных хемодектом. Креативная кардиология. 2015; 2: 72–80. DOI: 10.15275/kreatkard.2015.02.07
  8. Shamblin W.R., ReMine W.H., Sheps S.G., Harrison E.G. Carotid body tumor (chemodectoma): clinicopathologic analysis of ninety cases. Am. J. Surg. 1971; 122: 732–739. DOI: 10.1016/0002-9610(71)90436-3
  9. Persky M.S., Setton A., Niimi Y., Hartman J., Frank D., Berenstein A. Combined endovascular and surgical treatment of head and neck paragangliomas – a team approach. Head Neck. 2002; 24 (5): 423–431. DOI: 10.1002/hed.10068
  10. Van Der Bogt K.E.A., Vrancken Peeters M.P.F.M., Van Baalen J.M., Hamming J.F. Resection of carotid body tumors: results of an evolving surgical technique. Ann. Surg. 2008; 247 (5): 877–884. DOI: 10.1097/SLA.0b013e3181656cc
  11. Paridaans M.P.M., Van Der Bogt K.E.A., Jansen J.C., Nyns E.C.A., Wolterbeek R., Van Baalen J.M. et al. Results from craniocaudal carotid body tumor resection: should it be the standard surgical approach? Eur. J. Vasc. Endovasc. Surg. 2013; 46 (5): 624–629. DOI: 10.1016/j. ejvs.2013.08.010
  12. Sandow L., Thawani R., Kim M.S., Heinrich M.C. Paraganglioma of the head and neck: a review. Endocr. Pract. 2023; 29 (2): 141–147. DOI: 10.1016/j.eprac.2022.10.002
  13. Contrera K.J., Yong V., Reddy C.A., Liu S.W., Lorenz R.R. Recurrence and progression of head and neck paragangliomas after treatment. Otolaryngol. Head Neck Surg. 2020; 162 (4): 504–511. DOI: 10.1177/0194599820902702
  14. Бокерия Л.А., Иванов А.В., Абдулгасанов Р.А., Иванова Е.В. Методы диагностики инфекции сосудистых протезов. Клиническая физиология кровообращения. 2024; 21 (2): 93–106. DOI: 10.24022/1814-6910-2024-21-2-93-106
  15. Luna-Ortiz K., Rascon-Ortiz M., Villavicencio-Valencia V., Herrera-Gomez A. Does Shamblin’s classification predict postoperative morbidity in carotid body tumors? A proposal to modify Shamblin’s classification. Eur. Arch. Otorhinolaryngol. 2006; 263 (3): 171–175. DOI: 10.1007/s00405-005-0968-4
  16. Guha A., Musil Z., Vicha A., Zelinka T., Pacak K., Astl J. et al. A systematic review on the genetic analysis of paragangliomas: primarily focused on head and neck paragangliomas. Neoplasma. 2019; 66 (4): 671–688. DOI: 10.4149/neo_2018_181208N933
  17. Richter S., Pacak K., Kunst H.P.M., Januszewicz A., Nölting S., Remde H. et al. Management and follow-up strategies for patients with head and neck paragan-glioma. Eur. J. Endocrinol. 2024; 191 (4): 389–398. DOI: 10.1093/ejendo/lvae113
  18. WHO Classification of tumours: head and neck tumours. 5th ed. Lyon: IARC; 2024: 809.
  19. Lee J.H., Barich F., Karnell L.H., Robinson R.A., Zhen W.K., Gantz B.J. et al. National Cancer Data Base report on malignant paragangliomas of the head and neck cancer. Cancer. 2002; 94 (3): 730–737. DOI: 10.1002/cncr.10252
  20. Mediouni A., Ammari S., Wassef M., Gimenez-Roqueplo A.P., Laredo J.D., Duet M. et al. Malignant head/neck paragangliomas: comparative study. Eur. Ann. Otorhinolaryngol. Head Neck Dis. 2014; 131 (4): 159–166. DOI: 10.1016/j.anorl.2013.05.003
  21. Papaspyrou K., Mewes T., Rossmann H., Fottner C., Schneider-Raetzke B., Bartsch O. et al. Head and neck paragangliomas: report of 175 patients (1989–2010). Head Neck. 2012; 34 (4): 632–637. DOI: 10.1002/hed.21790
  22. Трембач Н.В., Трембач И.А., Заболотских И.Б. Периферическая хеморецепция при хронической сердечной недостаточности: подходы к изучению и клиническому значению. Клиническая физиология кровообращения. 2024; 21 (3): 182–200. DOI: 10.24022/1814-6910-2024-21-3-182-200
****
  1. Valero C., Ganly I., Shah J.P. Head and neck paragangliomas: 30-year experience. Head Neck. 2020; 42 (9): 2486–2495. DOI: 10.1002/ hed.26277
  2. Graham N.J., Smith J.D., Else T., Basura G.J. Paragangliomas of the head and neck: a contemporary review. Endocr. Oncol. 2022; 2: R153– R162. DOI: 10.1530/EO-22-0080
  3. Palade D.O., Hainarosie R., Zamfir A., Vrinceanu D., Pertea M., Tusaliu M. et al. Paragangliomas of the head and neck: a review of the latest diagnostic and treatment methods. Medicina (B Aires). 2024; 60: 914. DOI: 10.3390/medicina60060914
  4. Golukhova E.Z. Report on the clinical and scientific activity of Bakoulev National Medical Research Center for Cardiovascular Surgery for 2024. Development prospects. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2025; 26 (Special Issue) (in Russ.). DOI: 10.24022/1810-0694-2025-26S
  5. Harley R.J., Lee J.H., Ostrander B.T., Finegersh A., Pham T.B., Tawfik K.O. et al. Local tumor behavior associated with survival among patients with paraganglioma of the head and neck. OTO Open. 2022; 6. DOI: 10.1177/2473974X221086872
  6. Shubin A.A. Surgical aspects of the treatment of neck chemodectoma [dissertation]. Moscow; 2003 (in Russ.).
  7. Arakelyan V.S., Gazimagomedov Z.I., Abdulgasanov R.A. The results of diagnosis and surgical treatment of carotid chemodectomas. Creative Cardiology. 2015; 2: 72–79 (in Russ.). DOI: 10.15275/kreatkard.2015.02.07
  8. Shamblin W.R., ReMine W.H., Sheps S.G., Harrison E.G. Carotid body tumor (chemodectoma): clinicopathologic analysis of ninety cases. Am. J. Surg. 1971; 122: 732–739. DOI: 10.1016/0002-9610(71)90436-3
  9. Persky M.S., Setton A., Niimi Y., Hartman J., Frank D., Berenstein A. Combined endovascular and surgical treatment of head and neck paragangliomas – a team approach. Head Neck. 2002; 24 (5): 423–431. DOI: 10.1002/hed.10068
  10. Van Der Bogt K.E.A., Vrancken Peeters M.P.F.M., Van Baalen J.M., Hamming J.F. Resection of carotid body tumors: results of an evolving surgical technique. Ann. Surg. 2008; 247 (5): 877–884. DOI: 10.1097/SLA.0b013e3181656cc
  11. Paridaans M.P.M., Van Der Bogt K.E.A., Jansen J.C., Nyns E.C.A., Wolterbeek R., Van Baalen J.M. et al. Results from craniocaudal carotid body tumor resection: should it be the standard surgical approach? Eur. J. Vasc. Endovasc. Surg. 2013; 46 (5): 624–629. DOI: 10.1016/j. ejvs.2013.08.010
  12. Sandow L., Thawani R., Kim M.S., Heinrich M.C. Paraganglioma of the head and neck: a review. Endocr. Pract. 2023; 29 (2): 141–147. DOI: 10.1016/j.eprac.2022.10.002
  13. Contrera K.J., Yong V., Reddy C.A., Liu S.W., Lorenz R.R. Recurrence and progression of head and neck paragangliomas after treatment. Otolaryngol. Head Neck Surg. 2020; 162 (4): 504–511. DOI: 10.1177/0194599820902702
  14. Bockeria L.A., Ivanov A.V., Abdulgasanov R.A., Ivanova E.V. Methods for diagnosing infection of vascular prostheses. Clinical Physiology of Circulation. 2024; 21 (2): 93–106 (in Russ.). DOI: 10.24022/1814-6910-2024-21-2-93-106
  15. Luna-Ortiz K., Rascon-Ortiz M., Villavicencio-Valencia V., Herrera-Gomez A. Does Shamblin’s classification predict postoperative morbidity in carotid body tumors? A proposal to modify Shamblin’s classification. Eur. Arch. Otorhinolaryngol. 2006; 263 (3): 171–175. DOI: 10.1007/s00405-005-0968-4
  16. Guha A., Musil Z., Vicha A., Zelinka T., Pacak K., Astl J. et al. A systematic review on the genetic analysis of paragangliomas: primarily focused on head and neck paragangliomas. Neoplasma. 2019; 66 (4): 671–688. DOI: 10.4149/neo_2018_181208N933
  17. Richter S., Pacak K., Kunst H.P.M., Januszewicz A., Nölting S., Remde H. et al. Management and follow-up strategies for patients with head and neck paragan-glioma. Eur. J. Endocrinol. 2024; 191 (4): 389–398. DOI: 10.1093/ejendo/lvae113
  18. WHO Classification of tumours: head and neck tumours. 5th ed. Lyon: IARC; 2024: 809.
  19. Lee J.H., Barich F., Karnell L.H., Robinson R.A., Zhen W.K., Gantz B.J. et al. National Cancer Data Base report on malignant paragangliomas of the head and neck cancer. Cancer. 2002; 94 (3): 730–737. DOI: 10.1002/cncr.10252
  20. Mediouni A., Ammari S., Wassef M., Gimenez-Roqueplo A.P., Laredo J.D., Duet M. et al. Malignant head/neck paragangliomas: comparative study. Eur. Ann. Otorhinolaryngol. Head Neck Dis. 2014; 131 (4): 159–166. DOI: 10.1016/j.anorl.2013.05.003
  21. Papaspyrou K., Mewes T., Rossmann H., Fottner C., Schneider-Raetzke B., Bartsch O. et al. Head and neck paragangliomas: report of 175 patients (1989–2010). Head Neck. 2012; 34 (4): 632–637. DOI: 10.1002/hed.21790
  22. Trembach N.V., Trembach I.A., Zabolotskikh I.B. Peripheral chemoreception in chronic heart failure: approaches to study and clinical significance. Clinical Physiology of Circulation. 2024; 21 (3): 182–200 (in Russ.). DOI: 10.24022/1814-6910-2024-21-3-182-200

About Authors

  • Nidal A. Darvish, Cand. Med. Sci., Senior Researcher, Head of the Department; ORCID
  • Artem S. Vasilkov, Cardiovascular Surgeon; ORCID
  • Mussa F. Eseneev, Researcher, Cardiovascular Surgeon; ORCID
  • Mukhamed A. Shogenov, Cand. Med. Sci., Researcher, Cardiovascular Surgeon; ORCID
  • Vsevolod E. Ivashchenko, Researcher, Cardiovascular Surgeon; ORCID
  • Ramilya R. Valieva, Researcher, Cardiologist; ORCID
  • Natalya Yu. Svetlova, Cand. Med. Sci., Ultrasound Diagnostics Specialist; ORCID
  • Tatyana V. Zavalikhina, Cand. Med. Sci., Chief Physician of Bakoulev Center for Cardiovascular Surgery, Cardiologist; ORCID

 If you found mistakes, select text and press Alt+A