Carotid body tumors

We present our approach to the management of patients with carotid body tumors, emphasizing the role of magnetic resonance angiography for the identification of these tumors. Medical records of all patients with carotid body tumors who were managed between 1991 and 2001 were retrospectively reviewed. Nine patients with carotid body tumors were identified. There were four males and five females, ranging in age from 28 to 74 years. Duplux scanning, computed tomography (CT) scanning, and angiography were performed for seven patients, whereas Duplux and magnetic resonance angiography were performed for the remaining two patients. Eight patients underwent successful excision of the tumor. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in two patients. One patient developed local recurrence 5 years later. Early diagnosis of carotid body tumors with Duplex and magnetic resonance angiography is possible. Early surgery for carotid body tumors minimizes the risk of complications associated with large tumors.     

Carotid body tumors.

Between 1973 and 1984, five patients underwent excision of a carotid body tumor without operative mortality, cranial nerve palsy, cerebrovascular accident, or recurrence when followed to the present or to death from unassociated causes. The importance of preoperative four-vessel extracranial cerebrovascular arteriography for both diagnosis and planning of the operative approach cannot be overemphasized. These operations were performed without preoperative tumor embolization or transfusion, by selectively utilizing arterial resection, replacement, or repair, based on intraoperative evaluation of the individual tumor. Given the propensity of carotid body tumors to progressively enlarge, locally invade, and occasionally metastasize, all patients who are not prohibitive operative risks should undergo resection of carotid body tumors.     

Carotid body tumors: an analysis of 10 cases

Some problems of carotid body tumors regarding diagnosis and treatment are still controversial. From 1988 to 1998 we operated on 10 cervical paragangliomas in our Division of Vascular Surgery of Bari University. Three were bilateral and 2 were II Shamblin class. Seven tumors were considered familiar type (5 patients in the same family). Subadventitial dissection was performed in all cases after 4 vessel angiographies and Echo-dopplers. No complications occurred during the operation or post-operatively. Operative bleeding was reduced significantly by the use of subadventitial dissection which was accomplished in short times, thus avoiding more complicated and even hazardous techniques like clamping, sectioning or ligatures of the external carotid artery.     

Carotid body tumors and their operative problems (author's transl)]

Exstirpation of a neck tumor as an outpatient procedure became troublesome (bleeding). The surgeon had not realised the nature of the tumor.     

Carotid body tumors: a subject review and suggested surgical approach

Carotid body tumors are a rare but potentially difficult surgical entity. Their pathology, physiology, and natural history are reviewed along with surgical results reported in the literature. A surgical approach for removal of these tumors is presented which differs significantly from the recommended techniques in that emphasis is placed on intraoperative monitoring of cerebral blood flow, the the selective use of shunts, a tumor-adventitial plane of dissection, preservation of the carotid artery complex, and mobilization of the parotid gland. Thirteen cases using these techniques are reviewed. The mortality rate and the incidence of cerebrovascular sequelae were both 0%. The major morbidity consisted of injury to the lower cranial nerves in five patients (39%) with tumors larger than 5 cm in length.     

Carotid body tumors managed with preoperative embolization. Report of two cases

Two patients with large vascular carotid body tumors underwent preoperative intravascular embolization of the major arterial feeders. The tumor vascularity was reduced markedly, and complete surgical extirpation was accomplished without difficulty. The literature on carotid body tumors is briefly reviewed. The role of preoperative embolization in the treatment of these difficult tumors is emphasized.