0:01

Let's take a look at these two examples of carotid

0:04

by tumors. Vis-à-vis the Shamblin classification.

0:08

On the left side, you see a lesion which

0:11

has involvement that is 360 degrees.

0:15

Circumferential involvement of the internal and

0:17

external carotid artery. Here we have our ICA,

0:21

here we have our ECA, and you can see that the tumor

0:26

involves 360 degrees around the carotid bifurcation.

0:32

This is a case of a paraganglioma, which is not

0:36

necessarily "spraying" the internal

0:38

and external carotid artery,

0:39

but is circumferentially involving it.

0:41

And this is a Shamblin Group Three involvement where

0:46

in very likely the carotid artery

0:49

will need to be sacrificed.

0:51

Contrast that with this example of a carotid body

0:54

tumor where we have the internal carotid

0:57

artery and the external carotid artery.

1:00

The tumor. And in addition,

1:02

we look at the circumferential involvement of the

1:05

internal carotid artery, and it is effectively

1:08

180 degrees or less. Now,

1:11

we'd have to look at multiple sections to make that

1:14

determination, but if it's less than 180 degrees,

1:17

it's a Group One and therefore readily resectable.

1:20

If it's group 2180 to 270 degrees,

1:25

then it still can be resected with difficulty.

1:29

So this is how we look at the carotid body tumors

1:33

and give them a grade and try to give the clinicians

1:36

a sense of the degree of circumferential

1:38

involvement by the tumor.

1:41

So carotid body tumor imaging bifurcation mass

1:45

Splays the internal and external carotid

1:47

artery shows contrast-enhanced mint,

1:50

often has flow voids associated with it.

1:53

We look at the ADC value on a head and

1:56

neck MRI scan. If the ADC value is...

2:00

It implies that this is an aggressive tumor and

2:03

more likely to have some malign potential.

2:06

By and large, these are benign tumors.

2:09

Low ADC may be a marker that this has

2:12

undergone malign transformation.

2:14

We then report the case as far as the degree to

2:17

which there is circumferential involvement

2:19

of the internal carotid artery.

2:21

To give a sense of the Shamblin classification,

2:24

the MIBG scan, nuclear medicine scan,

2:28

which is metaiodobenzylguanidine or octreotide, is a nuclear medicine

2:30

agent that is relatively specific for these types

2:35

of neuroendocrine tumors, the paragangliomas,

2:38

and it can help in identifying multiple

2:43

paragangliomas in the neck or elsewhere in the body.