Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision

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Abstract

Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma.

Methods: Case report

Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere ^® and Contour ^® microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing.

Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

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Most cited references 12

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Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases.

W R Shamblin, W H ReMine, S G Sheps … (1971)

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A multicenter review of carotid body tumour management.

M. Sajid, Laura M S Baker, Graham Hamilton … (2007)

Carotid body tumour (CBT) is a rare but the most common form of head and neck paraganglioma (PGL). We present the biggest ever series on CBT in UK/EU discussing diagnostic challenges, surgical treatment and complications of surgical intervention. A detailed proforma was designed and sent to all members of Joint Vascular Research Group (JVRG). Data of 95 patients was collected. Generic terms including carotid body tumour/s, or paraganglioma/s were used to search a variety of electronic database in order to get latest informations available in literature. A total of 95 patients were recorded in our data from 1979 to 2005. Mean age of presentation was 55 years. Incidence was higher in females. CBT was more common on right side (58%). 18% tumours were bilateral. Neck lump (98%) and pressure symptoms including cranial nerve deficits and pain were main presenting complaints. About 18% of tumours were familial. Only 4.2% were malignant. Duplex scan is the best investigation for diagnosis, though MRI, DSA and CT scan are important for preoperative assessment. Surgery is the treatment of choice. Stroke and cranial nerve injury constitute postoperative morbidity (35%) and mortality (1%). Incidence of postoperative cranial nerve deficit was about 19%. Combined ipsilateral and contralateral recurrence rate was 4.2%. CBT is a rare condition which needs surgical excision by experienced vascular surgeon. Surgical resection is associated with significant morbidity of 35% and mortality of 1%. Mostly CBT is benign but malignant forms are not uncommon.

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Surgical Treatment of Carotid Body Paragangliomas: Outcomes and Complications According to the Shamblin Classification

Jae-Yol Lim, Jinna Kim, Sun Ho Kim … (2010)

Objectives The objective of this study was to review our experience in the surgical management of carotid body paragangliomas and evaluate the outcomes and complications according to the Shamblin classification. Methods Thirteen patients who had been diagnosed and surgically treated for carotid body tumors (CBTs) were enrolled in this study. We reviewed patient demographics, radiographic findings, and surgical outcomes collected from medical records. Results Fifteen CBTs were found in 13 patients and 13 tumors were resected. Selective preoperative tumor embolization was performed on six patients. The median blood loss, operation time, and hospital stay for these patients were not significantly reduced compared to those without embolization. The median tumor size was 2.3 cm in Shamblin I and II and 4 cm in Shamblin III. The median intraoperative blood loss was 280 mL and 700 mL, respectively (P<0.05). Internal carotid artery ligation with reconstruction was accomplished on three patients (23%), and they all belonged to Shamblin III (38%). One Shamblin III patient (8%) developed transient cerebral ischemia, and postoperative stroke with death occurred in another Shamblin III patient. Postoperative permanent cranial nerve deficit occurred in three patients (23%) who were all in Shamblin III (P=0.03). There were no recurrences or delayed complications at the median follow up of 29 months. Conclusion Shamblin III had a high risk of postoperative neurovascular complications. Therefore, early detection and prompt surgical resection of CBTs will decrease surgical morbidity.

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Author and article information

Journal

Journal ID (nlm-ta): GMS Ophthalmol Cases

Journal ID (iso-abbrev): GMS Ophthalmol Cases

Journal ID (publisher-id): GMS Ophthalmol Cases

Title: GMS Ophthalmology Cases

Publisher: German Medical Science GMS Publishing House

ISSN (Electronic): 2193-1496

Publication date (Electronic): 24 March 2017

Publication date Collection: 2017

Volume: 7

Electronic Location Identifier: Doc09

Affiliations

[1 ]Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia

[2 ]Retina and Vitreous Department, Clínica Oftalmológica del Café, Manizales, Colombia

[3 ]Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia

Author notes

*To whom correspondence should be addressed: Carlos M. Rangel, Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia, E-mail: carlosmrangel@ 123456hotmail.com

Article

Publisher ID: oc000060 Publisher ID: Doc09 Other ID: urn:nbn:de:0183-oc0000606

DOI: 10.3205/oc000060

PMC ID: 5366802

SO-VID: 63340974-8bb9-450c-a322-452e8a295051

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision

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Most cited references 12

Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases.

A multicenter review of carotid body tumour management.

Surgical Treatment of Carotid Body Paragangliomas: Outcomes and Complications According to the Shamblin Classification

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