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Program Number: B172
Session Name: Poster Session

The Periadventitial Plane: Pre-Operative Imaging Predicts Need for Internal Carotid Resection in Carotid Body Tumor Resection

Pratyusha Yalamanchi, MD, MBA¹; Ramez Philips, MD²; Ryan Rigsby, MD³; Liping Du, PhD³; Marina Aweeda, BA³; Carly Fassler, BA³; Kyle Mannion³; Eben Rosenthal, MD³; Alex Langerman, MD³; Robert Sinard, MD³; Melanie Hicks, MD³; Michael C Topf, MD³; Sarah L Rohde³; James Netterville, MD³; ¹University of Michigan; ²University of Chicago; ³Vanderbilt University

Importance: As patient age and symptomatology increasingly drive operative management of carotid body tumors, optimization of preoperative cross-sectional imaging interpretation can guide multidisciplinary surgical planning and anticipatory guidance.

Objective: To determine the impact of a novel preoperative radiographic sign on intraoperative and postoperative outcomes in patients undergoing carotid body tumor excision.

Design: Retrospective cohort study

Setting: Academic tertiary-care medical center

Participants: Procedures with available intraoperative data involving management of carotid body tumors were identified by CPT and ICD-9 and 10 codes collected from 2000-2017

Main Outcomes and Measures: Retrospective, blinded review of pre-operative cross-sectional imaging was performed by a neuroradiologist to identify presence of a radiographic plane between the internal carotid artery and carotid body tumor. Patient characteristics, operative variables, and postoperative outcomes were determined.  The relationships between tumor characteristics, Shamblin classification, and preoperative radiographic plane between the internal carotid artery and the carotid paraganglioma (referred to as the Periadventitial Plane), and intraoperative carotid resection and reconstruction were evaluated using standard univariate and multivariate analyses.

Results: Among 82 cases of carotid body tumor excision, mean patient age at time of surgery was 45 years (SD 13.2), tumor size 3cm (SD 1.3cm), 48.8% of tumors were Shamblin II classification and 30.5% were Shamblin III classification, and tumor necrosis was identified on pre-operative imaging in 19.5% of cases (see Table 1). As shown in Figure 1, Periadventitial Plane on preoperative imaging was highly predictive of intraoperative internal carotid resection (AUC 89.1% (79.4%-98.8%), sensitivity 90.8%) independent of established predictors such as Shamblin classification (AUC 73.5% (60.7%-86.3%), sensitivity 63.3%) and tumor size (AUC 73.5% (60.7%-86.3%)). Multivariate regression identified patient age, presence of tumor necrosis on imaging, and periadventitial plane to be 98% predictive of need for internal carotid resection (CI 95.3%-100%).

Figure 1: Left - area under the curve (AUC) findings from multivariable regression of patient and tumor characteristics predictive of ICA resection on univariate analysies. Right - example photo of the Periadventitial Plane in a carotid body tumor

Conclusions and Relevance: Here we demonstrate the internal carotid artery Periadventitial Plane on preoperative imaging to be a novel, highly predictive radiographic method for need for internal carotid artery resection and reconstruction during operative management, facilitating preoperative planning for head and neck and vascular surgeons and anticipatory guidance for patients.

 

 

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