Management for carotid body paragangliomas

Abstract

The carotid body tumor is a rare neoplasm that has generated much literature over the last century, and for which continued controversy exists regarding natural history, biologic behavior, proper technique of excision, and the risk of morbidity and mortality. The present study reviewed a 16-year experience of managing carotid body paraganglioma (CBP) between 1988 and 2004. There were 10 consecutive patients aged between 18-42 years with tumors and median follow-up was 10 years. Preoperative information was derived from spiral CT scanning, magnetic resonance imaging (MRI), color Doppler imaging (CDI), and four-vessel digital subtraction arteriography. In five patients the tumor excision was attempted before they were referred to our tertiary care hospital. Two patients had bilateral tumors. Four patients had preoperative embolization, and blood loss was minimal, and excision was relatively easier in them. There was difficulty in deglutition (nasal and laryngeal regurgitation) in three patients with large tumors and who required nasogastric tube feeding (1 to 3 weeks). Surgical planning and prediction of peri-operative complications can be obtained by digital subtraction angiography, spiral CT angiography and color Doppler imaging. The peri-operative blood loss can be reduced by preoperative embolization.

Clamping of external carotid artery rather than embolization during surgical removal of a huge carotid body tumor

“…The problem is surgical resection of large CBT is challenging, technically difficult and had an increasing risk of neurovascular injuries [6]. In order to avoid common postoperative neurovascular complication many suggested preoperative embolization of the feeding vessels could reduce blood loss and improve tumor excision [7,8]. The ascending pharyngeal artery is the most common major feeding artery for CBTs.…”

“…The carotid body (also known as glomus gland) is a gland located behind the carotid artery at the site of its bifurcation on either side of the neck, normally about www.ijcasereportsandimages.com Sayed Ali et al 7 5 mm in size and covered with a fibrous capsule. The gland acts as peripheral chemoreceptor which releases neurotransmitter primarily in response to decrease in the arterial partial pressure of oxygen and by a lesser extent to increase in the partial pressure of CO2 and decrease in arterial pH.…”

Atypical Complications Following Surgical Excision of Carotid Body Tumours

“…11 Surgical excision has been preferred, as it is the only available curative therapy; 2,12 all carotid body tumors eventually become symptomatic and have the potential to undergo malignant transformation, which occurs in 10-15%. 5,7,8 However, excision is a potentially morbid procedure, frequently associated with excess damage to nearby vascular and neural structures.…”

“…4,5 e estimated incidence is 1 in 30,000, seen most commonly in middle-aged individuals, with a slight predilection for women. 6,7,9 A well-recognized etiology of the sporadic type is chronic hypoxia; for example, carotid body tumors are seen more frequently in those living at high altitude and with chronic obstructive pulmonary disease. 6,7 Carotid body tumors are typically asymptomatic and slow to proliferate; as a result, they may exist for years before an individual seeks medical attention.…”

“…6,7,9 A well-recognized etiology of the sporadic type is chronic hypoxia; for example, carotid body tumors are seen more frequently in those living at high altitude and with chronic obstructive pulmonary disease. 6,7 Carotid body tumors are typically asymptomatic and slow to proliferate; as a result, they may exist for years before an individual seeks medical attention. Most commonly, patients present with a hard, pulsatile, and typically painless mass in the upper neck.…”