The patient data taken into account were: age, gender, tumour size, bilaterality, postoperatively mortality and morbidity Temsirolimus nmr and recurrence during follow-up. Average age was 51 years (range: 24-74 years) and 40% of patients were males. CCU was performed as the first diagnostic approach in all patients with an Ultramark 9 ATL Philiphs equipment in the first part of this experience and with a Toshiba Aplio XP equipment successively. Typical ultrasound features included the presence of

a solid hypoechoic vascular mass with a low-resistance flow pattern at Doppler frequency analysis, a hypervascular pattern at colour and power Doppler imaging; CCU also showed intrinsic carotid disease

if present. Neck angio-CT and angio-MR were combined to ultrasounds to define tumour feeding vessels, the relationship with the adjacent structures and the cranial extension in the neck for a better planning of the best surgical approach. Total body angio-CT was not performed to minimize the risks related to the high dose of radiation burden for CT. Digital substraction carotid angiography (DSA) was carried out in those cases scheduled for endovascular preoperative embolization performed in order to reduce tumour vascularity and size; embolization was always followed by operation within 1 or 2 days. During DSA, contemporary balloon internal carotid blockade (Mata’s test) was performed to determine the patient’s tolerance to carotid cross-clamping. The sensitivity this website of this test was improved

by the use of transcranial Doppler monitoring. Preoperative total body SRS- SPECT was carried out by intravenous injection of 150 MBq 111In-pentetretide (StarCam 2000 at first and then StarCam 4000i). Nuclear scans included head, neck, chest, abdomen and pelvis and were repeated at 4 and 24 hours after injection with medium energy collimators and both 171 keV and 245 keV with a 15% window. The protocol included a 40-minute acquisition on 128 × 256 matrix. SPECT images were obtained by many 30-minute acquisition on 64 × 64 matrix by using the same collimators. All perioperative scans were evaluated by the same nuclear medicine physician. If abnormal radioactivity was detected in other regions of the body than neck, nuclear scans would have been repeated for the same areas during the follow-up. Table 1 summarizes the diagnostic methods employed for pre-operative evaluation in all cases. Table 1 Preoperative investigation modalities in 16 CBTs Technique n. CBTs (%) Color-coded imaging 16 (100%) Indium 111In-pentreotide scintigraphy -SPECT* 16 (100%) Angio-MR 7 (58.3%) Angio-CT 9 (75%) Digital selective angiography** 8 (66.