Carotid body tumours: surgical management and predictors of operative risk

In spite of a low but constant incidence of neurologic complications, resection of carotid body tumours of all sizes in appropriate surgical candidates has been advocated as the sole line of treatment of these rare lesions. This study summarizes our experience in the diagnosis and treatment of these lesions trying to identify the factors that predict the magnitude of operative risk.22 patients with 23 non-familial carotid body tumours presenting to the Cairo and Alexandria University Hospitals over a 4-year period were reviewed. There were 10 females and 12 males and the mean age was 42 years. A preoperative diagnosis, of being carotid body tumour, was not reached in 7 patients. In the remaining 16 tumours, duplex scanning, angiography, CT scanning and MRA clenched the diagnosis preoperatively, one tumour had FNAB and another open biopsy. 21 tumours were resected and the remaining 2 were irradiated. Internal carotid artery reconstruction employing great saphenous vein was required in 7 cases, end to end anastomosis in one case and lateral repair in another. A temporary shunt was used in 5 instances. Three patients suffered a transient hemiparesis while another 3 suffered a transient hypoglossal nerve palsy .It was concluded that surgical resection remains an effective form of treatment but is not without risk. The predictors of operative difficulty and hence increased risk include lack of preoperative diagnosis, mid and large sized tumours, Shamblin classes 2 and 3, use of FNAB as well as previous surgery