Bilateral carotid body tumor case: A novel preoperative management

Abstract

Paragangliomas are rare neuroendocrine neoplasms. The most common form of these tumors in head and neck are non-functional carotid body tumors. These neoplasms may present an extensive growth and compromise vital neurovascular structures in the neck, such as carotid vessels. Carotid body tumors usually present clinically as painless neck masses and occur most frequently in adults averaging 45 to 50 years, being the majority of these tumors unilateral and only 5% of all cases bilateral. The main treatment for carotid body paragangliomas is surgical resection, which can be extremely challenging due to tumor hypervascularity and significant blood loss. We present a bilateral carotid body tumor case in a 61-year-old woman who presented due to a pulsatile and painless mass in the right carotid region of the neck of 1-year of evolution. The tumor was found encasing the external carotid artery and classified as Shamblin II. A novel approach for preoperative management was performed, placing a covered graft-stent in the right common and proximal (C1) internal carotid arteries in order to splint and provide structural protection for carotid vessels during surgical resection and temporarily reduce blood flow of the carotid body tumor.

The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis

“…Preoperative embolization helps reduce the complications associated with bleeding and resection of giant tumors, but is complicated and costly, and may lead to inflammation and carotid artery injury, increasing the risk of ischemic stroke. No consensus has been reached regarding indications for preoperative embolization [ 17 ]. Radiotherapy is often used as an adjuvant therapy for inoperable patients, while surgical resection is currently the recommended clinical treatment option.…”

Current trends in carotid body tumors: Comprehensive review

“…If these nerves are injured, radiotherapy would be the best alternative to prevent the risk of baroreflex failure syndrome. 53 Overall, it is hard to extrapolate the real effects of radiotherapy to a wider population as most of the studies describing radiotherapy for CBT were reserved for the worst or more complex cases. Nevertheless, radiotherapy is a well-known alternative for patients who cannot undergo surgery due to age, comorbid conditions, or to minimize the risk of baroreflex failure syndrome and avoid its long term treatment.…”

“…Only after confirming functional IX and X nerves, surgical excision of the contralateral tumor can be performed. If these nerves are injured, radiotherapy would be the best alternative to prevent the risk of baroreflex failure syndrome 53 …”