Analysis Of Adverse Events Related To Carotid Body Tumor Surgery And Research On The Evaluation Value Of Preoperative CTA

Background:Prompt surgical resection is considered an ideal treatment for carotid body tumor(CBT).The growth of CBT is closely related to cranial nerves and blood vessels.Therefore,surgical resection of CBT has high risks of hemorrhage and cranial nerve injury(CNI),which not only affects the quality of life of patients after surgery but even endangers the lives of patients.It is very important to predict the occurrence and risk factors of surgery-related complications beforehand.OBJECTIVE:To measure CBT by post-processing using Computed Tomography Angiography(CTA).Appropriate statistical methods were used to analyze the measurement parameters and complications related to CBT surgery.Exploring the risk factors of complications related to CBT surgery and establishing a predictive model for complications to guide surgeons in preoperative preparation and surgical planning are the scientific issues to be solved in this study.Methods:This study was a single-center retrospective cohort study.According to the inclusion criteria,109 CBT patients in our center from June 2015 to June 2020 were included.Eighty-nine patients(96 CBTs)were selected for analysis by exclusion criteria.1.Use the head and neck vessel analysis tool in the CTA post-processing software.The system automatically identifies the free distal segment length of the internal carotid artery(FDS-ICA)as determined in a curvilinear-linear reformatting reconstruction of the internal carotid artery.To further demonstrate the shape of the association between FDS-ICA and permanent CNI,we performed a smooth curve fit by entering FDS-ICA into the model to test for linear trends.If nonlinearity is detected,we first calculate the turning point using a recursive algorithm and then construct a two-piece binary logistic regression model on both sides of the turning point.The threshold level is determined by choosing the turning point that provides the maximum model likelihood.2.The researchers imported the data into the 3D Volume module to obtain volumes through steps such as region growing and region deletion.Univariate analysis and multivariate analysis were used to evaluate the prognostic value of age,volume,DTBOS and Shamblin classification of 4 known predictors in predicting intraoperative bleeding after CBT resection.Four prognostic models were established.Model 1 included CBT volume alone,Model 2 added Shamblin classification to Model 1,Model 3 added distance to the base of skull(DTBOS)to Model 2,and Model 4 added all 4 known predictors.For each model,we provided odds ratios with 95% confidence intervals to describe the effect size of each predictor,C statistic used as a measure of prediction accuracy.Results:1.The operation time was 168.90±102.99 minutes,and the estimated blood loss(EBL)was 200.00(100.00-650.00)ml.All patients did not experience a drop in heart rate and blood pressure during the operation.Thirteen cases of CBT underwent intraoperative revascularization,and the average postoperative hospital stay was 4.29±2.23 days.After a full year of postoperative follow-up and review,a total of 17(17.71%)cases of CBT had permanent CNI,and some patients had two mixed permanent CNIs at the same time.2.Patients with permanent CNI complications had a shorter mean FDS-ICA than those without permanent CNI complications(21.94 ± 16.60 mm VS 38.61 ± 14.08mm)(p <0.001).For every 1 mm increase in FDS-ICA,the risk of permanent CNI was reduced by8%(p=0.01).In an analysis of the threshold effect of FDS-ICA on p-CNI,we determined that the turning point of the effect of FDS-ICA on permanent CNI was 28.7 mm.3.The results of the stratified analysis showed that in Shamblin Ⅲ CBT,for every1 mm increase in DTBOS,EBL decreased by 27.38(8.31,46.44)ml;for every 1cm3 increase in volume,EBL increased by 18.79(10.38,27.20)ml(P<0.05).In multivariate analysis,the bleeding volume decreased by 11.97(0.79,23.16)ml for each 1-year increase in age.We constructed 4 models,of which Model 4(including age,volume,DTBOS,Shamblin classification)(C Statistic,0.909;95% CI,0.849-0.969)was more valuable in predicting major intraoperative bleeding compared with the other three models(P<0.05).Conclusion:All 96 cases of CBT in this study were completely resected.CTA image analysis for evaluating permanent CNI after CBT resection is feasible and effective.FDS-ICA is a novel preoperative imaging predictor whose acquisition method is simple and accurate.Studies have confirmed that FDS-ICA is an independent predictor of permanent CNI.Patients with low FDS-ICA(especially less than 28.7 mm)are at relatively high risk for permanent CNI complications.This new predictive index supports CBT preoperative CTA imaging assessment to improve risk stratification and management of patients with carotid body tumors.We provide a new strategy for preoperative assessment and recommend multidisciplinary collaboration for CBT close to the skull base and the use of intraoperative neurophysiological monitoring.This study also verified that the volume of CBT,DTBOS,Shamblin classification,and age are risk factors for major bleeding during CBT resection,and combined these four major risk factors to establish a predictive model,which showed strong predictive ability.It is feasible and effective to assess intraoperative bleeding risk before CBT resection.Combining the model to formulate a more complete and accurate surgical plan may solve the current controversial issue of preoperative embolization and identify people who are more suitable for preoperative embolization.