Approach to surgical management of carotid body tumor and our experience at Assiut University Hospital

ABSTRACT

Carotid body tumor [CBT] is a rare neoplasm, which typically presents as a slow growing, painless neck mass found along the anterior border of the sternocleidomastoid muscle. This tumor is generally benign but possesses aggressive resection remains a surgical challenge traditionally associated with a 15-30% incidence of cranial nerve injury. To present our experience at Assiut University Hospital regarding surgery of CBT and the use of preoperative embolization and mandibulotomy in large sized tumors. The study was performed on 18 cases with CBT, 5 females and 13 males with a mean age of 40 years. Clinical and radiological diagnosis was recorded. Angiography was done in 17 cases for confirmation of CBT diagnosis and its extent, evaluation of carotid arteries and for preoperative emobilization. One case due to some technical difficulties was evaluated by spiral CT angiography. Patients were classified according to the tumor size and Shamblin classification. Preoperative imobilization to decrease the tumor vascularity and the intraoperative blood loss, was done. Patients were subjected to surgical removal of the tumor through anterior longitudinal approach to the carotid system not later than 4 days after the embolization to avoid the inflammatory phase and the development of any collaterals. Paramedian mandibulotomy was done in cases with very large tumore. Patttients presented with painless swelling, local tenderness, bruit, difficulty with swallowing, and hoarseness. Preoperative embolizaiton for large cases decreases the tumor vascularity by [25% to 45%][as documented by post embolization films. The average blood replacement was one unit. There were no deaths and complications were recorded in 44.4% of patients as vascular complications [legation of external carotid artery, simple repair of internal carotid artery, and repair of internal carotid artery with interposition of vein graft] or neurological complications as cerebrovascular stroke, injury of vagus, hypoglossal and marginal mandibular nerves. All cases were confirmed histologically as benign paragangliomas. CBT should be taken in considerations in all lateral neck masses. Angiograhy is very helpful in making the diagnosis. Preoperative embolizaiton decreases the tumor size, the vascularity and facilitates the subsequent surgery. Paramedian mandibulotomy provided a wide exposure, in cases with large sized tumors. Early detection and resection of smaller tumors ultimately reduced the risk of complications