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ABSTRACT Carotid body paragangliomas represent an uncommon neoplasm in dogs. The objective of this study was to report outcomes and complications associated with surgical excision of carotid body paragangliomas in 21 dogs. Cases were recruited retrospectively via medical record review from 9 veterinary speciality centres. The perioperative complication rate was 52% (11/21). Complications encountered in this cohort related to removal of carotid body tumour included airway obstruction, aspiration pneumonia, megaesophagus, unilateral laryngeal paralysis, coughing and Horner's syndrome. The overall perioperative mortality rate was 4.7% (1/21 dogs) and median survival time was 554 days for the six patients with known dates of death. One‐ and two‐year survival rates were 61% and 42%, respectively. This is the largest collection of carotid body paraganglioma cases reported in veterinary literature. Based on these results, surgical resection of carotid body paragangliomas was associated with low perioperative mortality and long survival times. [ABSTRACT FROM AUTHOR]

Carotid body tumour (CBT) is the most common paraganglioma of the head and neck and may compromise neurovascular structures such as carotid vessels, and cranial nerves. Intracranial extension from the mass is possible if left untreated. The main treatment for CBT is surgical resection albeit extremely challenging due to tumour hypervascularity and its relationship to the carotid artery. A bilateral CBT, however, is a rare occurrence. Herein, we present a case of a man who presented to us with bilateral painless and palpable neck mass. He underwent staged bilateral CBT excision and it was complicated with left hypoglossal nerve palsy, which recovered over time. [ABSTRACT FROM AUTHOR]

Carotid body tumours (CBT), also called carotid body paraganglioma, are highly vascular and histologically portray paraganglion cells. They are typically found at the carotid bifurcation and result in the splaying of the internal and external carotid arteries (ICA and ECA). Recent literature supports the role of chronic hypoxia in the etiology of CBT. This pictorial essay discusses how CBT is an uncommon etiology for common clinical problems such as transient ischemic attacks. It also discusses imaging techniques to precisely map out the tumour for surgical resection using advanced imaging modalities and techniques. [ABSTRACT FROM AUTHOR]

Objective: The determination of clinico-surgical predictors of carotid body tumour (CBT) metastasizing and/or recurrence., Methods: Patients with CBT but without a history of its previous treatment who had received inpatient medical aid at a tertiary surgical centre during the period 2011-2021 were retrospectively reviewed to obtain baseline data. Primary endpoints of the study were CBT metastasizing and/or local recurrence after radical surgery (composite endpoint) and overall survival. Secondary endpoint of the study was primary patency of carotid arteries that had been repaired/reconstructed as a result of CBT removal. Suspected predictors of CBT metastasizing/recurrence were young age of CBT onset, positive family history, multifocal paraganglioma, Shamblin type III CBT, carotid bifurcation and/or internal carotid artery (ICA) reconstruction as a result of CBT excision. To detect CBT metastasizing/recurrence, prospective imaging-based whole-body screening was suggested to patients., Results: Fifty-three patients met the eligibility criteria. The overall survival rate was 100% at a median follow-up time of 68 months (interquartile range [IQR] 27‒104.5 months). The primary patency of repaired carotid arteries ( n = 9) was 88.9% at a median follow-up time of 99 months (IQR 15.5‒116.5 months). Thirty-nine patients underwent the prospective whole-body screening. Eight (20.5%) patients were diagnosed with metastatic disease ( n = 6) or local recurrence ( n = 2). Patients with CBT metastasizing/recurrence were younger at age of CBT onset ( p = .011), more frequently had Shamblin type III CBT ( p = .004) and the necessity for carotid artery repair/reconstruction ( p = .041) than patients without metastasizing/recurrence. These two groups were similar in terms of gender ( p = .682), the prevalence of multifocal paraganglioma ( p = .167) and positive family history ( p = .180). Only the belonging of a CBT to Shamblin type III was defined as a statistically significant predictor of CBT metastasizing/recurrence in both univariable and multivariable binary logistic regression analyses (odds ratio 30; 95% confidence interval: 2.649-339.739; p = .006 and odds ratio 75.409; 95% confidence interval: 1.082-5254.557; p = .046, respectively). Multifocal paraganglioma as a predictor exhibited a strong tendency towards statistical significance ( p = .09 and p = .072, respectively). Other suspected predictors didn't reach the level of statistical significance either in univariable ( p = .151 for positive family history) or in multivariable ( p = .211 for age of CBT onset; p = .734 for carotid artery reconstruction/repair) binary logistic regression analyses., Conclusion: Shamblin type III CBT has high potential for metastasizing and recurrence. Patients with Shamblin type III CBT and/or multifocal paraganglioma should be considered for genetic testing as well as preoperative whole-body radiological imaging and long-term postoperative whole-body imaging-based follow-up., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The carotid body is the largest collection of paraganglia in the head and neck and is found on the medial aspect of the carotid bifurcation bilaterally. Carotid body tumours are rare neoplasms arising from the chemoreceptor cells of the carotid bulb. We report a case of carotid body tumour in a 46-year-old male, who presented with painless, pulsatile, gradually progressive lateral neck swelling. The diagnosis is suspected on the basis of history, clinical and radiological examination findings and a successful surgical excision of the tumour is performed. Histopathological examination confirms the diagnosis of carotid body tumour. (Paraganglioma) In this article we present brief about carotid body tumours in terms of its clinical and imaging presentation, evaluation, and management (pre & post surgical management). [ABSTRACT FROM AUTHOR]

Background: Presentation of case reviews depicting the imaging characteristics of carotid paragangliomas, associated with a thorough analysis of the anatomical morphological features and the current therapeutic strategies.Materials and Methods: We present the cases of 3 patients diagnosed with carotid paragangliomas in our clinic, illustrating diagnostic imaging elements by computer tomography (CT) and magnetic resonance imaging (MRI), but also the postoperative aspect of the carotid system, with respective anatomical, clinical and surgical considerations.Results: The imaging aspect of the carotid paragangliomas is characterised by a mass of soft tissue with intense contrast enhancement and with "salt and pepper" MRI appearance on conventional spin-echo sequences. The postoperative evolution of the patients included in the article was favourable, without any perioperative complications or signs of local tumour recurrence.Conclusions: Carotid paragangliomas are rare, often asymptomatic tumours, but with potential for increased malignancy, which raises the need for good knowledge of the cervical region pathology as well as the features of neuroendocrine tumours. CT and MRI examinations are essential for diagnosis, staging and, implicitly, for establishing the therapeutic strategy. [ABSTRACT FROM AUTHOR]

A 2.5-kg, eight-year-old, neutered male Yorkshire Terrier was presented for evaluation of a cervical mass that had first been noticed a year earlier. A firm spherical mass located caudal to the left mandible was found on physical examination. Ultrasonography revealed a well-defined, round-shaped mass located medial to the left mandibular salivary gland that was approximately 2.6 cm in height, 2.3 cm in width and 3 cm in length. Volume-rendered images obtained by computed tomography (CT) showed that the left external and internal carotid arteries and internal jugular vein were encased in the mass. A definitive diagnosis of carotid body tumour was made based on histopathology. The tumour and the carotid arteries and internal jugular vein encased in the tumour were resected using CT-based surgical planning. The regional neural structures were preserved by careful blunt dissection. The dog had a mild hacking cough after swallowing and hoarseness that disappeared spontaneously five days and two months, respectively, after surgery. There was no evidence of recurrence or distant metastasis at 18 months postoperatively. This case report describes successful surgical management of a carotid body tumour with ligation and transection of the carotid arteries in a dog. To the authors' knowledge, this is the first report of successful surgical treatment of an advanced carotid body tumour based on CT findings.

Carotid body tumours are rare tumours arising from chemoreceptor cells at the bifurcation of carotid artery. They are highly vascular and mostly benign but with potential to turn into malignancy. Even though tumours are nearly always non functional, catecholamineproducing tumours do exist and can produce paroxysmal hypertension. As surgical removal is the commonest mode of treatment, anaesthetic management poses several challenges. Here we report a case of carotid body tumour excision with an eventful perioperative course.

Objectives The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. Methods This is a systematic review and meta-analysis of 104 observational studies. Results Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79–2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91–4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5–31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42–14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92–3.82), increasing to 2.71% (95% CI 1.43–5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34–6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62–5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94–16.68) for Shamblin II, and 17.10% (95% CI 14.82–19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45–7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56–13.08) vs. no embolisation (5.82%; 95% CI 2.76–11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). Conclusions This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI. [ABSTRACT FROM AUTHOR]

Paragangliomas (PGLs) are neuroendocrine neoplasms that can occur throughout the body wherever there is paraganglia. Representing 0.03% of all tumours, PGLs are extremely rare. Although predominantly benign and amenable to cure by surgical ressection, up to 6% can be malignant. To date, three genes have been identified that are associated with Familial PGLs. All three encode subunits (D, B and C) of the enzyme succinate dehydrogenase complex (SDH), which is part of the Kreb's cycle and the electron transport chain. We report a novel causative frameshift mutation in the subunit D of SDH (SDHD) in a family with Carotid Body Paragangliomas. This finding contributes for extending the known mutational spectrum of SDHD, and to help the genetic counseling of this family. Noteworthy, is now possible to offer to other relatives, still sub-clinical, a predictive test that would eventually aid an early surveillance/intervention for a better prognosis.

The carotid body tumour is the most common head and neck paraganglioma arising from the carotid bodies located at the bifurcation of the common carotid arteries. These are very rare tumors with an incidence of 0.012% in general population. They present as slow growing, asymptomatic neck masses of varying duration. They occur in sporadic, hereditary and hyperplastic variants. The hereditary forms tend to be bilateral, functional and carry higher risk of malignancy. The angiography is the modality of choice for diagnosis and treatment planning. The surgical resection is the mainstay of treatment which can be performed with acceptable complication rates in experienced centres. We report the case of a 37-year-old lady who presented with a slowly growing mass on the right side of the neck for which she under went surgery and histopathological examination confirmed the diagnosis of carotid body tumour.

Background: Cervical paragangliomas (CPG) are slow-growing tumours, most of which are highly vascular, making surgical resection challenging. Preoperative embolisation of afferent arteries has been recommended to facilitate operative dissection, reduce perioperative blood loss, and shorten the duration of the operation. However, there is conflicting evidence on the benefits of preoperative embolisation on surgical outcomes, operative time, and bleeding., Objectives: The objective of this study was to compare the perioperative parameters and outcomes like duration of surgery, blood transfusion, duration of stay in the ICU, cranial nerve injuries, and postoperative stroke between patients who underwent excision of CPGs with and without preoperative embolisation., Methods: This is a retrospective study conducted at the Division of Vascular Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. The study included a review of the medical records of 32 patients who underwent excision of CPGs. Patients who underwent surgical resection without preoperative embolisation (SR) were compared with those who underwent surgical resection with embolisation (SREMB). Statistical analysis was done in R statistical software (R Foundation for Statistical Computing, Vienna, Austria). Categorical variables were reported in absolute numbers and percentages continuous variables were compared with an unpaired Mann-Whitney U test. The chi-square test was used to compare the categorical data., Results: Out of 32 patients included in this study, 13 (40.6%) patients were included in the SREMB group. Between the two groups, there were no significant differences in operative time (120 vs. 150 minutes; p = 0.59), blood transfusion requirement (0.69 vs. 0.37 units; p = 0.39) and ICU stays (1 vs. 1; p = 0.56). Postoperative cranial nerve injury was significantly more in the SREMB group (6 vs 1; p = 0.01) but stroke (0 vs 2; p = 0.50) was not statistically significant between the two groups., Conclusion: In this study, we found that there was insufficient evidence to support routine preoperative embolisation in CPG. Hence, preoperative embolisation should only be used in a very select group of patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rajendran et al.)

Objective: In the Netherlands, the majority of hereditary head and neck paragangliomas (HNPGL) are caused by germline variants in the succinate dehydrogenase genes (SDHD, SDHB, SDHAF2). Here, we evaluate a four‐generation family linked to a novel SDHB gene variant with the manifestation of a HNPGL. Design: A family‐based study. Setting: The VU University Medical Center (VUmc) Amsterdam, a tertiary clinic for Otolaryngology and Head and Neck Surgery. Participants and main outcome measures: The index patients presented with an embryonic rhabdomyosarcoma and a non‐Hodgkin lymphoma. Array‐based comparative genomic hybridisation (aCGH) analysis and multiplex ligation‐dependent probe amplification (MLPA) revealed a novel deletion of exon 1‐3 in the SDHB gene, suspected to predispose to paraganglioma (PGL)/pheochromocytoma (PHEO) syndrome type 4. Subsequently, genetic counselling and DNA testing were offered to all family members at risk. Individuals that tested positive for this novel SDHB gene variant were counselled and additional clinical evaluation was offered for the identification of HNPGL and/or PHEO. Results: The DNA of 18 family members was tested, resulting in the identification of 10 carriers of the exon 1‐3 deletion in the SDHB gene. One carrier was diagnosed with a carotid body PGL and serum catecholamine excess, which was surgically excised. Negative SDHB immunostaining of the carotid body tumour confirmed that it was caused by the SDHB variant. The remaining 9 carriers showed no evidence of PGL/PHEO. Conclusion: Deletion of exon 1‐3 in the SDHB gene is a novel germline variant associated with the formation of hereditary HNPGL. [ABSTRACT FROM AUTHOR]

Paragangliomas (PGL) develop from the parasympathetic system in the head and neck (HN) and arise primarily in four distinct areas: Carotid body, vagal, middle ear, and larynx. Globally, the diagnosis and morphologic features are the same regardless of anatomic site, however the incidence, frequency of genetic alterations/syndromes and differential diagnosis vary. It is now recognized that nearly 40% of all HN PGLs are hereditary, including a significant subset without a known family history. Now pathologists are central to the evaluation for diagnosis and further management of patients with HNPGLs. Specifically, SDHB immunohistochemical evaluation is an excellent screening tool to detect tumors with alterations in the SDH family of genes that represent the majority of hereditary cases in HNPGL. Similarly, SDHB immunohistochemical analysis allows for screening of PGL syndrome associated tumors (gastrointestinal stromal tumor (GIST), renal cell carcinoma (RCC), and pituitary adenomas) that have now been linked by their overlapping gene alterations. Awareness of the spectrum of these syndromes, and their associated tumors, positions the pathologist to augment patient care and surveillance. [ABSTRACT FROM AUTHOR]

Carotid body tumours are rare and mostly benign neoplasm. They are slow growing but can evade or exert pressure on neighbouring important neurovascular structures. Hence, surgical resection remains the treatment modality of choice for large tumours partially or completely encasing the carotid arteries. But the surgical resection of these tumours with minimum morbidity is challenging because of their highly vascular nature. Earlier literature has dealt with various aspects of management of carotid body tumours including classification, morbidity, work-up, embolisation and extent of resection. However, the options in techniques of dissection for carotid body tumours have not been elaborated much. Here, we describe a stepwise dissection technique of carotid body tumours from the internal carotid towards the external carotid artery. This surgical technique, named as 'the internal to external (INT-EX) technique', provides better control of bleeding during the surgery, ease of dissection and lesser post-operative morbidity. [ABSTRACT FROM AUTHOR]

Background Paraganglioma is a rare neuroendocrine tumour arising anywhere along the paravertebral sympathetic and parasympathetic chains. In the neck, paraganglioma may affect the carotid body (carotid body tumour). Case report We describe a 43-year-old woman who presented with a reversible vasoconstriction syndrome associated with a posterior reversible encephalopathy syndrome following a surgery for a left carotid paraganglioma (with a past medical history of surgery for a right carotid paraganglioma a few months before). Conclusion A consequence of a baroreflex modification is discussed in order to explain the rare occurrence of such symptoms. [ABSTRACT FROM AUTHOR]

Carotid body tumours are rare tumours arising from chemoreceptor cells at the bifurcation of carotid artery. They are highly vascular and mostly benign but with potential to turn into malignancy. Even though tumours are nearly always non functional, catecholamine-producing tumours do exist and can produce paroxysmal hypertension. As surgical removal is the commonest mode of treatment, anaesthetic management poses several challenges. Here we report a case of carotid body tumour excision with an eventful perioperative course. [ABSTRACT FROM AUTHOR]

Paragangliomas (PGs) of the head and neck region are typically benign, slow-growing neuroendocrine tumours. At times, they may exhibit unusual histological features, such as prominent stromal sclerosis (sclerosing PG), which may raise concerns of malignancy. We describe a case of sclerosing PG of the carotid body, emphasizing the value of immunohistochemical stains for differential diagnosis. A 43-year-old woman presented with a painless lump on the neck. A magnetic resonance imaging scan demonstrated a hypervascular lesion of the carotid body, which was surgically excised. Grossly, the lesion measured 1.8 cm at maximum diameter. On microscopic examination, irregular nests and tiny bundles of neoplastic cells were found between thick bands of fibrous tissue. Focal nuclear cytomegaly and marked pleomorphism were noted. Neoplastic cells proved to be immunoreactive for chromogranin, synaptophysin and neuron specific enolase, but negative for cytokeratins, smooth muscle actin and CD34. Ultrastructurally, numerous mitochondria, rough endoplasmic reticulum structures and endocrine granules were seen in the cytoplasm of the tumour cells. On consideration of the above-mentioned clinico-pathological and ultrastructural findings a diagnosis of sclerosing PG was established. Sclerosing PG is a rare entity which may mimic a malignant neoplasm. The recognition of this unusual morphological variant of PG, together with appropriate immunostains, leads to the correct diagnosis. [ABSTRACT FROM AUTHOR]

The surgical resection of a large unfavourable Shamblin type III carotid body tumour (CBT) can be very challenging technically, with many potential significant complications. Preoperative embolization aids in shrinking the lesion, reducing intraoperative blood loss, and improving visualization of the surgical field. Preoperative internal carotid artery (ICA) stenting aids in reinforcing the arterial wall, thereby providing a better dissection plane. A woman presented to our institution with a large right-sided CBT. Failure of the preoperative temporary balloon occlusion (TBO) test emphasized the importance of intraoperative preservation of the ipsilateral ICA. A combination of both preoperative embolization and carotid stenting allowed a less hazardous radical resection of the CBT. An almost bloodless surgical field permitted meticulous dissection, hence reducing the risk of intraoperative vascular and nerve injury. Embolization and carotid stenting prior to surgical resection should be considered in cases with bilateral CBT or a skull base orientated high CBT, and for those with intracranial extension and patients who have failed the TBO test. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to review treatment results in patients with paraganglioma (PGL) of the neck presenting as carotid body tumour, long-term follow-up and relevance of genetic testing for succinate dehydrogenase (SDH)-gene mutations. Design: Retrospective analysis of prospectively collected data and prospective genetic analysis. Materials and Methods: Over a 25-year period (1987–2011) 50 patients were operated for 63 PGLs of the neck. Pre-, intra- and postoperative findings were analysed. Sanger sequencing was performed for genetic testing of SDH-gene mutations (SDH B, SDHC and SDHD). Results: Fifty patients underwent resection of 63 PGLs (62 benign, one malignant) without mortality. Eight patients underwent preoperative embolisation. Vascular surgical procedures were required in 15 operations (15/63 = 23.8%). Nerve lesions occurred after 13 operations (13/63 = 20.6%) and were associated with large tumours. A total of 44 patients are alive after a mean follow-up of 9.8 years. In 40 patients 17 SDH-gene mutations were detected (17/40 = 42.5%): 14 SDHD mutations, two SDHB mutations and one rare SDHC mutation. Conclusion: Surgery for PGL is recommended. All PGL patients should be screened for SDH mutations because it impacts the individual follow-up strategy. Whereas all PGL patients require annual ultrasound control, mutation carriers and family members with proven mutations should in addition be regularly examined by magnetic resonance imaging (MRI) of head, neck, thorax, abdomen and pelvis. [Copyright &y& Elsevier]

Abstract: Functional carotid body tumours are rare, but linked to malignant hypertension, postoperative persistent hypotension, cranial nerve injury and stroke. The aim of this study is to analyze the treatment options for functional carotid body tumours. Six patients with functional carotid body tumours who underwent surgical procedures were studied retrospectively. They all had abnormal levels of preoperative catecholamine (norepinephrine, 721±452.2ng/l). One patient presented preoperative hypertension. Preoperative alpha- and beta-adrenergic blockade was carried out. Surgical methods included complete resection (6), saphenous vein interposition (3) and carotid shunt (1). With thorough supervision and treatment, the 6 patients underwent tumour resection. They all experienced intraoperative hypertension while the tumours were being resected. Postoperative problems included endurance hypotension (3/6, 50%), coughing when drinking (3/6, 50%) and deviation of the tongue on protrusion (3/6, 50%). The clinical highlights of functional carotid body tumour include preoperative abnormal catecholamine, peroperative fluctuations of blood pressure level, and regime issues. Operative resection could be the best option for functional carotid body tumours. Careful preoperative evaluation, measurement of serum catecholamine, treatment for alpha- and beta-adrenergic blockade, and gentle intraoperative manipulation are essential to avoid life-threatening complications. [Copyright &y& Elsevier]

Summary: Objective: Review of the treatment of cervical paraganglioma. Material and methods: Review of the literature based on a Medline database. Results: The treatment of choice consists of a multidisciplinary approach based on a detailed clinical, laboratory and radiological work-up. Vascular reconstruction may be necessary when the tumour invades the artery wall. The main complication of surgery is damage to cranial nerves involved in speech and/or swallowing. Treatment of bilateral tumours must be conducted in two stages. The first side to be operated depends on the sites and size of the tumours, as the primary objective is to avoid bilateral vagus nerve palsy. Radiotherapy has been used to treat paragangliomas for several years and achieves tumour stabilization in the majority of cases. Potential indications reported in the literature are: inoperable tumours, recurrence after surgery, some bilateral tumours and malignant tumours. Conclusion: Surgery is the standard treatment for cervical paraganglioma. Radiotherapy can be proposed when surgery is contraindicated. [Copyright &y& Elsevier]

Objective:We report a patient with a malignant carotid body paraganglioma treated with surgery and adjuvant radiotherapy. We discuss her treatment and outcome in the light of the published literature.Case report:A 26-year-old woman presented with a 12-month history of a painless, left-sided neck lump. Ultrasound, computed tomography and magnetic resonance imaging revealed a carotid body tumour, which at surgical excision was found to be adherent to the vagus and hypoglossal cranial nerves (X and XII). The tumour was resected from the surrounding structures. Two local lymph nodes were removed to allow access. The internal carotid artery was also involved and had to be repaired with a synthetic graft. Histology and immunohistochemistry confirmed malignant carotid body paraganglioma. There were positive resection margins, and cervical lymph node metastasis was reported in one of the two nodes. Post-operatively, she had left Horner's syndrome, left vocal fold palsy and right upper limb weakness, all of which resolved spontaneously. She underwent adjuvant radiotherapy and remained recurrence free after 30 months.Conclusion:Malignant carotid body paraganglioma can affect young adults, with an insidious onset of symptoms. In this patient, local excision (without neck dissection) and adjuvant radiotherapy were well tolerated and resulted in satisfactory local disease control. [ABSTRACT FROM PUBLISHER]

The 'Lyre' sign describes the characteristic splaying of the carotid artery bifurcation due to a carotid body tumour (paraganglioma) on conventional carotid angiography. In this pictorial review, we describe and illustrate two cases demonstrating the equivalent Lyre sign on multi-detector computed tomography (MDCT) and ultrasound resulting from carotid body tumour and extra-cranial internal carotid artery pseudoaneurysm. Both of these pathologies can manifest acutely and warrant accurate diagnosis to prevent potential catastrophic consequences. We also emphasise the added value of MDCT in making a definitive diagnosis and discuss other differential considerations splaying the carotid bifurcation. [ABSTRACT FROM AUTHOR]

Lateral skull base tumours arise from overlying skin, parotid, temporal bone, mandible, muscle or the vasculature and they spread in midst of important neurovascular structures. This makes their diagnosis and management challenging. These tumours are primarily dealt with surgery which can be extensive, functionally disabling and cosmetically disfiguring. Tumour biology, involvement of the internal carotid artery and cranial nerves play key roles in management of these tumours. This review will focus on management of common tumours afflicting the lateral skull base. [ABSTRACT FROM AUTHOR]