Carotid body tumors: a review.

Carotid body tumors are encountered rarely and can present a difficult surgical problem. We reviewed the records of 16 patients with 19 tumors, who were entered in the Head and Neck Tumour Registry of the University of Toronto. There were no functionally secreting tumors and no patients with metastases. Most tumors were identified pre-operatively by clinical examination and angiography. However, five were found at open biopsy and required a second procedure. The mortality rate was 0 following embolization. One patient suffered a severe CNS complication and one patient a TIA. The major morbidity resulted from cranial nerve palsies in seven out of 16 patients. Recently, we have utilized a new method for resection of these highly vascular tumors that results in less blood loss and an increased ease of removal.     

Carotid body tumors: A review of 30 patients with 46 tumors

Minimal morbidity occurs with resection of most carotid body tumors (CBT). With larger tumors significant injury to the cranial nerves has been reported. In order to assess the operative sequelae rate, 30 patients with CBT were reviewed. Sixteen patients either presented with bilateral carotid body tumors or had previously undergone a resection of the contralateral carotid body tumors, for a total carotid body tumor count of 46. Sixteen patients demonstrated a familial pattern while 14 were nonfamilial. Within the familial group, 14 of 16 presented with multiple paragangliomas as compared to 6 of 14 in the nonfamilial group. Tumor size ranged from 0.8 to 12 cm. Vascular replacement occurred in 2 of 20 patients with tumors <5.0 cm, compared with 5 of 9 with tumors >5.0 cm. Four patients lost cranial nerves with the resection: superior laryngeal nerve (SLN), 4; cranial nerve X, 1; cranial nerve XII, 1. Ten patients developed baroreceptor failure secondary to bilateral loss of carotid sinus function. First-bite pain occurred in 10 of 25 operative patients. Cranial nerve loss can be minimal with resection of carotid body tumors, however, baroreceptor failure and first-bite pain are postoperative sequelae that are often disregarded in the postoperative period.     

Carotid body paragangliomas. A clinicopathologic and DNA analysis of 13 tumors

The clinical and pathological features of 13 carotid body paragangliomas from 12 patients were examined and correlated with the DNA ploidy pattern as determined by image analysis. These tumors occurred in 7 women and 5 men aged 19 to 62 years (average, 42 years). All presented with a slowly enlarging, usually asymptomatic mass of 2 weeks' to 25 years' duration. Two patients were related and had a family history of paragangliomas. The tumors ranged from 2 to 6 cm. All contained scattered chief cells with pleomorphic nuclei, two exhibited mitoses, and three showed perineural and three vascular invasion. Follow-up was available in all 12 patients and ranged from 15 months to 28 years (average, 7.3 years). None of the tumors recurred locally, but one did metastasize to a single cervical lymph node that was apparent at the time of diagnosis. Of 13 carotid body paragangliomas examined for DNA, 4 were diploid, 3 diploid-tetraploid, 3 tetraploid, 2 aneuploid, and 1 polyploid. The only malignant tumor was polyploid. From these observations, we conclude that abnormalities in DNA content of carotid body paragangliomas are common and that tumor ploidy cannot be used to assess malignant potential. We also found no apparent relationship among nuclear pleomorphism, mitotic activity, perineural invasion, or vascular invasion and clinical behavior. Perineural and vascular invasion, however, were observed only in tumors with abnormal DNA histograms.     

Carotid body paraganglioma with metastases

The diagnosis of a carotid body paraganglioma with metastases led us to a critical review of the literature of 106 cases with metastasis reported between 1893 and 1980. The percentage of tumors with metastasis is in the order of 11.5% to 13%. There is no proven histological criterion from which to assert or infer their malignancy.     

Management of carotid body tumors

The carotid body tumor is a rare neoplasm that has generated much literature over the past century, and for which continued controversy exists regarding natural history, biologic behavior, proper technique of excision, and the risk of morbidity and mortality. This article discusses overall management of carotid body tumors.     

诊治颈动脉体瘤4例体会

报告诊治4例颈动脉体瘤的体会。认为彩色Doppler超声（彩超）检查和颈动脉造影，尤其是数字减影血管造影（DSA）对诊断颈动脉体瘤具有较高的价值。本病的唯一治疗方法是手术；术前应行颈总动脉压迫锻炼，为手术创造条件；术式的选择主要根据术前彩超和DSA结果，以及术中所见肿瘤与颈动脉的关系而定。     

颈动脉切除重建术在头颈肿瘤中的应用

目的 探讨颈动脉切除重建术在累及颈动脉的头颈肿瘤外科治疗中的应用价值.方法 分析7例累及颈动脉的头颈肿瘤患者一期切除肿瘤和颈动脉及颈动脉重建手术的方法、效果及5术后并发症,3例为ShamblinⅢ型颈动脉体瘤,2例为喉癌术后复发并颈部淋巴结转移,2例为喉咽癌术后复发或放疗后并颈部淋巴结转移.结果 7例患者均在颈动脉转流下切断颈动脉,肿瘤连同颈动脉整块切除,采用自体大隐静脉或聚四氟乙烯膨体(expanded polytetrafluoroethylene,ePTFE)人工血管重建颈动脉.所有患者术后均未出现中枢神经系统并发症,2例颈动脉体瘤患者出现单侧喉返神经麻痹和霍纳综合征.1例患者因咽瘘导致颈动脉破裂二次行颈动脉重建术;2例患者术后形成咽瘘,其中1例出现肿瘤复发,1例经换药愈合.结论对于累及颈动脉的头颈肿瘤,颈动脉切除重建术有可能降低手术后神经系统并发症发生,改善患者的生活质量.     

Carotid body and glomus vagale tumours (author's transl)]

Twentyfour chemodectomas (non-chromaffin paragangliomas) of the neck seen in 20 patients are presented. The investigation including angiography and the surgery in respect to risk factors and preoperative assessment is discussed. The long term results are also presented. Special note is made of the familial incidence since two twin brothers who had bilateral tumours are included.     

Carotid resection and reconstruction for locally advanced head and neck tumors

Head and neck surgeons hesitate to resect the carotid artery because of the postoperative risk of neurologic sequelae. However, there is no curative therapeutic option for head and neck neoplasms involving the carotid artery, with the exception of complete tumor removal. To evaluate the benefits and risks of carotid revascularization techniques in locally advanced head and neck tumors we performed a retrospective analysis in an institutional, tertiary care medical center. Seven patients (5 males, 2 females) with a median age of 58 years underwent en bloc removal of locally advanced head and neck tumors, including carotid resection and revascularization, in the University of Vienna General Hospital, over a 15-year period. In six patients carotid reconstruction was accomplished by bypass grafting (five autologous grafts, one synthetic graft) and in one patient angiopatchplasty was used. There were no perioperative neurologic complications or deaths. Survival was > 12 months in 5/7 patients; the other 2 patients died within 6 months due to untractable progression of cancer. We conclude that carotid revascularization techniques offer the possibility of better local control for advanced head and neck tumors without additional risks of neuromorbidity or mortality.     

Carotid body tumour. Exicsion with resection of carotid arteries.

A case of carotid body tumour is reported and the salient features of its histopathology have been described. Its excision with resection of the carotid arteries can be safely undertaken if the tumour is of long duration, the angiography shows marked displacement of the carotid arteries and if the blood pressure is maintained during surgery by regulating the blood transfusion and lowering the head end of the patient, thereby preventing fatal brain hypoxia. The fact that it is a potentially malignant and radioresistant tumour, makes its excision with or without ligation of the carotid arteries almost imperative.     

Carotid body paraganglioma: an uncommon localization. A case report

Paraganglioma are rare lesions, which come from neural cells. They arise the most frequently from carotid body. The tumor is classically located in the carotid bifurcation, between internal and external carotid arteries. We report a case of carotid body paraganglioma which is uncommonly located under the carotid bifurcation.