Carotid Body Tumors and Our Surgical Approaches

Abstract

Glomus tumors known as paragangliomas are neoplasms arising from the neural crest. They are named according to the place they originate from. Tumors originating from the carotid body at the carotid bifurcation are called Carotid Body Tumors (CBT). Surgical intervention is planned according to the Shamblin classification. 17 patients were operated after being diagnosed with CBT in our clinic between February 2007 and June 2010. 12 (70.5%) of the patients were male, and 5 (29.4%) of the patients were female. The average age was 42 (ages ranging between 32 and 47). Nine of the patients were diagnosed and treated with Shamblin type I tumor, seven of the patients with type II and one patient with type III. Only one patient had bilateral carotid tumor. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly by means of thermal cautery in the subadventitial plane. The patient with Shamblin type III had tumor invasion in the carotid artery and adjacent tissues were in an adherent state. Therefore mass resection was carried out by resecting 2 cm of the distal portion of the common carotid artery and 3 cm of the proximal portion of the internal carotid artery. 6 mm of synthetic polytetrafluoroethylene graft was interpositioned between the common carotid artery and the internal carotid artery. External carotid artery was anastomosed to this graft in an end-to-end fashion. The patient developed vocal cord paralysis postoperatively on the lesion side. The patient who underwent bilateral tumor excision developed Baroreflex Failure Syndrome. In the two patients thrombus developed in the internal carotid artery in the early postoperative period. These patients underwent thrombectomy and developed hemiplegia on the lesion side. One of them died on the seventh post-operative day while in follow-up in the intensive care unit. Surgical resection is the recommended treatment for carotid body tumors. Shamblin I and II type tumors' dimensions and pathological characteristics allow dissection. However Shamblin III tumors may require carotid artery resection and reconstruction due to tissue invasion. The possibility of post-operative cranial nerve paralysis and arterial thrombosis should be taken into account.

Carotid Body Tumors: A Review of 25 Years Experience in Diagnosis and Management of 56 Tumors

“…16) The combined use of CCU and somatostatin receptor scintigraphy with planar and single photon emission tomography was found beneficial in identifying the extent of tumors, and degree of arterial infiltration. 14) CT and MRI show the infiltration in the neck and in between the vessels. MRA is more preferable than MRI as it gives both images of the tumor and data on the vascular involvement.…”

“…feeding vessels of the tumor, confirming the patency of the Circle of Willis, identifying the presence of other head and neck paragangliomas, DSA can identify the dominant feeding vessel, thereby allowing for preoperative embolization. 12,14,15) Color coded ultrasonography (CCU) allows early and non-invasive accurate detection of tumors with 100% sensitivity even when not palpable. 16) The combined use of CCU and somatostatin receptor scintigraphy with planar and single photon emission tomography was found beneficial in identifying the extent of tumors, and degree of arterial infiltration.…”

“…12,15,17) DSA is now being replaced by the emerging MDCT, which provides an accurate angiogram and adds the advantage of detecting the extent and the relation to the skull base and surrounding structures in case of large CBTs. 14) Octreotide scanning, a nuclear medicine imaging procedure, could also be useful for detecting the presence of multicentric or metastatic paragangliomas, and for distinguishing scar from residual tumor after surgery. 12) Although it was described that the carotid body is located in the adventitia of the carotid bifurcation, 6,12) others, 7,17,18) including the authors believe that it lies in the peri-adventitial plane.…”

A meta‐analysis on the surgical management of paraganglioma of the carotid body per Shamblin class

“…In line, there were no differences in LC rates between the ICA manipulation/reconstruction group and the remaining tumours. Nonetheless, 3 studies used standardised ICA manipulation methods, of which only Arya et al describe potential adverse events . No difference in local control or CND rates was found in these studies.…”

Karotis Cisimcigi Paragangliomalarinda Cerrahi Deneyimimiz ve Literatur Derlemesi

“…Fizik muayenede boyundaki kitlenin kranio-kaudal yönde hareketi kısıtlıyken horizontal planda rahat mobilize olması tipiktir ve Fontaine bulgusu olarak isimlendirilir (10). Fizik muayeneyi takiben yapılacak ultrasonografi (USG), manyetik rezonaslı görüntüleme (MRG), bilgisayarlı tomografi (BT) ve dijital substraction anjiografi (DSA) ile tanı konulabilmektedir (2).…”