Proposed modification to the Shamblin's classification of carotid body tumors: A single-center retrospective experience of 116 tumors.

OBJECTIVES: Carotid body tumors (CBTs) are rare head and neck neoplasms, we aimed to propose a modification to the Shamblin's classification of CBTs. MATERIALS AND METHODS: This retrospective study included 105 patients (116 CBTs) operated at our institution from March 2013 to July 2020. CBTs were divided by a modified Shamblin's classification into five subtypes (type I-V) based on the radiographic features. Correlations between modified classification and intraoperative bleeding, internal carotid artery (ICA) bypass and postoperative neural complications, as main outcomes, as well as other outcomes were analyzed. RESULTS: Surgeries for type V and type I CBTs had the most (median: 700 ml, IQR: 375-1575 ml) and least (median: 20 ml, IQR: 20-50 ml) bleeding, respectively. Intraoperatively, ICA bypass was needed in 41.7% (10/24) type V, 18.2% (8/44) type IV and 5.9% (1/17) type III lesions, but not in other subtypes (p = .001). Postoperatively, overall cranial nerve deficits (CND) were found most frequently in type V tumors (17/24, 70.8%) (p = .016). Permanent CND were found in 33.3% (8/24) type V and 4.5% (2/44) type IV lesions, but not in other subtypes (p = .001). Other outcomes including external carotid artery ligation, operation time, blood transfusion, postoperative intensive unit care and postoperative hospitalization also showed significant difference among different subtypes. Patients recovered uneventfully during a follow-up of 23.5 ± 16.2 months except for one ipsilateral recurrence at 42 months after surgery. CONCLUSIONS: The modified classification was correlated with surgical outcomes of CBTs and will be helpful for making surgical plans.

Update in the classification and the role of intra-arterial stenting in the management of carotid body paragangliomas.

BACKGROUND: To review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra-arterial stenting in their surgical management. METHODS: Retrospective case series of 20 patients with 28 CBPs that were surgically resected at our center. Intra-arterial stenting was performed in Shamblin II and II classes. RESULTS: The mean follow-up was 47.8 months. Five (17.9%) tumors were Shamblin class I, 15 (53.6%) were class II, and 8 (28.6%) were class III. Thirteen (68.4%) CBPs were associated with other paragangliomas. The internal carotid artery (ICA) was stented preoperatively in eight (28.6%) cases and occluded in four (14.3%) cases. The tumor extended to the jugular foramen in six cases (21.4%). Intraoperatively, there was an ICA injury in one case of Shamblin II CBP in the present era. CONCLUSIONS: The proposed classification enables the clinician to plan the management of the ICA and the right approach. Stenting of the ICA gives a chance for complete tumor removal with arterial preservation.

Surgical management of carotid body tumor - Is Shamblin classification sufficient to predict surgical outcome?

Background The study aims to conduct a review of the surgical management of carotid body tumor. Methods Consecutive patients with CBT who received surgical interventions from January 1994 to January 2014 at our institution were reviewed. Clinical, operative, pathological and follow up information were reported. Results Twenty patients (four males; median age was 36) with 21 CBT operations were recorded during the period. One patient undertook sequential operations for bilateral CBTs. Patients had 19 neck mass, 1 incidental finding and 1 facial nerve palsy. Six CBTs (28.6%) were Shamblin class I, ten (47.6%) were class II and five (23.8%) were class III. Nine CBTs had preoperative conjunctive embolization. Two operations required internal carotid artery resection and reconstruction. Four patients received subtotal resections, while 17 achieved complete resection. Complications included two major strokes, three hoarse voice and two Horner's syndrome. Shamblin class was significant predictor of operative time, blood loss, and whether complete resection accomplished, but could not predict postoperative complication. With median follow up period of 94 months, there was no tumor recurrence found in those had complete resection. Conclusions This small cohort showed that Shamblin class was significant in predicting technical difficulties but could not predict occurrence of complications.

[Carotid body paraganglioma in a teenager. Case report]. / Paraganglioma del cuerpo carotídeo en adolescente. Reporte de caso.

BACKGROUND: Paragangliomas of the head and neck are neuroendocrine tumors. They have a low incidence (0.6%), are generally benign, have a poorly defined etiology, and multiple factors have been associated with their origin. Humans and other species living at high altitudes (>2000 m above sea level) are subjected to a relatively chronic hypoxia and there is a high prevalence of the development of carotid body hyperplasia and eventually paragangliomas. This disease is usually seen in patients in their 50s and in their 30s if there is a family history. CLINICAL CASE: We present the case of a 16 year-old female with acute pharyngitis and growing tumor located on the left side of the neck, without symptoms. A duplex Doppler ultrasound showed a solid nodular lesion on the left carotid bifurcation. A left lateral cervicotomy was performed, finding a highly vascularized tumor of 4 × 3 × 3 cm involving the common carotid from its middle third, the internal carotid up to the cranial base, and the external carotid to its upper third, and intimately related to the trachea, esophagus and cervical spine. The tumor was completely resected and the histopathological analysis corroborated the presence of paragangliomas. CONCLUSIONS: The publication of this case is relevant and of clinical interest due to the uncommon age of presentation and the fact that it should be considered as a diagnostic possibility.

Antecedentes: los paragangliomas de cabeza y cuello son tumores neuroendocrinos de baja incidencia (0.6%), en su mayor parte benignos, en cuyo origen se han involucrado múltiples factores. Los seres humanos y otras especies que viven a grandes alturas (por arriba de 2000 metros sobre el nivel del mar) son propensos a sufrir hipoxia crónica relativa, hiperplasia del cuerpo carotídeo y, eventualmente, paragangliomas. Este padecimiento aparece en la quinta década de la vida y en la tercera, en caso de presentación familiar. Caso clínico: se comunica el caso de una adolescente de 16 años de edad que un año antes tuvo faringitis aguda con tumor localizado en la cara lateral izquierda del cuello, de crecimiento gradual, sin ningún síntoma. El ultrasonido Doppler dúplex de cuello mostró una lesión nodular sólida sobre el trayecto de la bifurcación carotídea izquierda. Fue intervenida quirúrgicamente mediante cervicotomía lateral izquierda, en la cual se encontró una tumoración de aproximadamente 4 × 3 × 3 cm, sumamente vascularizada, que afectaba la carótida común desde su tercio medio, la carótida interna hasta la base del cráneo y la carótida externa hasta el tercio superior, con íntima relación con la tráquea, el esófago y la columna cervical. La tumoración se resecó en su totalidad, el estudio histopatológico corroboró los paragangliomas. Conclusiones: la edad de presentación es poco común, por lo que se considera relevante y de interés clínico comunicar este caso, toda vez que debe considerarse como posibilidad diagnóstica.

Results from craniocaudal carotid body tumor resection: should it be the standard surgical approach?

OBJECTIVES: To evaluate results after carotid body tumor (CBT) surgery using a novel dissection technique. METHODS: A retrospective analysis of all operated CBT in the last 6 years was carried out and results were compared with the current literature and our previous series, which reported another 111 cases operated on until 2005. RESULTS: Forty-five CBTs were removed in 41 (56% hereditary cases) patients (seven Shamblin I, 22 II, and 16 III). There were no cases of permanent cranial nerve injury or stroke. These pre- and postoperative results compare favorably with our previous series and are superior to, generally smaller, studies reported in the contemporary literature. CONCLUSIONS: This large series of surgically-treated CBTs supports craniocaudal dissection as the surgical technique of choice as it limits blood loss and facilitates safe CBT resection.

Head and neck paragangliomas: clinical and molecular genetic classification.

Head and neck paragangliomas are tumors arising from specialized neural crest cells. Prominent locations are the carotid body along with the vagal, jugular, and tympanic glomus. Head and neck paragangliomas are slowly growing tumors, with some carotid body tumors being reported to exist for many years as a painless lateral mass on the neck. Symptoms depend on the specific locations. In contrast to paraganglial tumors of the adrenals, abdomen and thorax, head and neck paragangliomas seldom release catecholamines and are hence rarely vasoactive. Petrous bone, jugular, and tympanic head and neck paragangliomas may cause hearing loss. The internationally accepted clinical classifications for carotid body tumors are based on the Shamblin Class I-III stages, which correspond to postoperative permanent side effects. For petrous-bone paragangliomas in the head and neck, the Fisch classification is used. Regarding the molecular genetics, head and neck paragangliomas have been associated with nine susceptibility genes: NF1, RET, VHL, SDHA, SDHB, SDHC, SDHD, SDHAF2 (SDH5), and TMEM127. Hereditary HNPs are mostly caused by mutations of the SDHD gene, but SDHB and SDHC mutations are not uncommon in such patients. Head and neck paragangliomas are rarely associated with mutations of VHL, RET, or NF1. The research on SDHA, SDHAF2 and TMEM127 is ongoing. Multiple head and neck paragangliomas are common in patients with SDHD mutations, while malignant head and neck paraganglioma is mostly seen in patients with SDHB mutations. The treatment of choice is surgical resection. Good postoperative results can be expected in carotid body tumors of Shamblin Class I and II, whereas operations on other carotid body tumors and other head and neck paragangliomas frequently result in deficits of the cranial nerves adjacent to the tumors. Slow growth and the tendency of hereditary head and neck paragangliomas to be multifocal may justify less aggressive treatment strategies.

Head and neck paragangliomas: clinical and molecular genetic classification

Head and neck paragangliomas are tumors arising from specialized neural crest cells. Prominent locations are the carotid body along with the vagal, jugular, and tympanic glomus. Head and neck paragangliomas are slowly growing tumors, with some carotid body tumors being reported to exist for many years as a painless lateral mass on the neck. Symptoms depend on the specific locations. In contrast to paraganglial tumors of the adrenals, abdomen and thorax, head and neck paragangliomas seldom release catecholamines and are hence rarely vasoactive. Petrous bone, jugular, and tympanic head and neck paragangliomas may cause hearing loss. The internationally accepted clinical classifications for carotid body tumors are based on the Shamblin Class I-III stages, which correspond to postoperative permanent side effects. For petrous-bone paragangliomas in the head and neck, the Fisch classification is used. Regarding the molecular genetics, head and neck paragangliomas have been associated with nine susceptibility genes: NF1, RET, VHL, SDHA, SDHB, SDHC, SDHD, SDHAF2 (SDH5), and TMEM127. Hereditary HNPs are mostly caused by mutations of the SDHD gene, but SDHB and SDHC mutations are not uncommon in such patients. Head and neck paragangliomas are rarely associated with mutations of VHL, RET, or NF1. The research on SDHA, SDHAF2 and TMEM127 is ongoing. Multiple head and neck paragangliomas are common in patients with SDHD mutations, while malignant head and neck paraganglioma is mostly seen in patients with SDHB mutations. The treatment of choice is surgical resection. Good postoperative results can be expected in carotid body tumors of Shamblin Class I and II, whereas operations on other carotid body tumors and other head and neck paragangliomas frequently result in deficits of the cranial nerves adjacent to the tumors. Slow growth and the tendency of hereditary head and neck paragangliomas to be multifocal may justify less aggressive treatment strategies.

Tumor de cuerpo carotídeo / Carotid body tumor

Carotid body tumors (paragangliomas) are very rare, highly vascularized and usually benign tumors, originated in the carotid body chemoreceptors. We present the cases of two asymptomatic patients referred for left cervical mass; preoperative study was CT and CT angiography, respectively, which are consistent with carotid body tumors. The tumors were completely removed by subadventitial disection without complications; the biopsy was compatible with paraganglioma. No evidence of recurrence could be found.

Los tumores de cuerpo carotídeo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotídeo. Se presentan los casos de dos pacientes derivados por aumento de volumen cervical izquierdo, asintomáticos, con estudio preoperatorio realizado por TAC y angiografía por TAC, respectivamente, que resultan compatibles con tumores de cuerpo carotídeo. Se resuelven quirúrgicamente, mediante disección subadventicial, informando la biopsia paraganglioma. Los tumores fueron completamente removidos, sin evidencia de recurrencia y sin mayores complicaciones.

Carotid body tumour resection with LigaSure device.

OBJECTIVE: We carried out this study in patients who underwent resection of carotid body tumour (CBT). Shamblin's classification system was used as well as the modified Shamblin classification. We sought to determine whether surgical time and bleeding could be reduced with the use of the LigaSure system. METHODS: A prospective study was carried out in patients with CBT. RESULTS: A decrease in both time and bleeding was shown, although only overall time showed statistical significance. Cases were classified as Shamblin I, II and III in two, six, and four cases, respectively, and after surgical treatment were classified as modified Shamblin I, II, IIIa and IIIb in two, one, and six cases, respectively, by infiltration to the carotid. There was nerve damage in four cases, and there were three carotid resections. CONCLUSIONS: Use of LigaSure decreased bleeding and surgical time in CBTs. Lesions of the artery are mainly caused by infiltration or by muscular hypotrophy of the artery, which frequently requires vascular reconstruction. Nerve injury continues to be an important postoperative complication, which may result in a reduction in the quality of life for the patient. The rates of nerve injury as a result of surgery were unchanged.

[Carotid body tumor. An often misdiagnosed disease]. / Chemodectoma carotideo. Una entità spesso misconosciuta.

Chemodectomas are uncommon neoplasms, born by glomic cell of extra-adrenegic system. Usually, these neoplasms are benign and non functioning, but when they are more than 4 cm can induce a neuro-vascular compressive syndrome. In this study the Authors propose the guidelines for diagnostic, clinical and therapeutic management, of these tumors according to their experience.

[Surgical treatment of carotid paragangliomas]. / Tratamiento quirúrgico de los paragangliomas carotídeos.

The present article reviews the current panorama of the surgical treatment of carotid paragangliomas. The article begins by discussing surgical indications and preoperative aspects (Shamblins classification, the value of genetic study, informed consent, the utility of embolization, etc). Intraoperative aspects (surgical team) and features of the surgical technique (the patients position, incision and exposition, vessel control and identification of nerves, subadventitial or periadventitial tumoral excision, the need for arterial resection and reconstruction, etc.) are discussed in depth. Postoperative aspects, morbidity (neurological and vascular) and mortality, as well as how to follow-up these patients, are discussed at the end of the first part of the article. The second part analyzes special situations concerning carotid paraganglioma (unresectable, malignant, residual [persistent] or recurrent, bilateral and multiple tumors, associated diseases, tumors in children, etc.). The final part of the article, in the form of an appendix, shows the characteristics and results of our series (30 carotid paragangliomas in 26 patients between 1994 and 2008).

Tratamiento quirúrgico de los paragangliomas carotídeos / Surgical treatment of carotid paragangliomas

Este artículo revisa el estado actual del tratamiento quirúrgico de los paragangliomas carotídeos. Las indicaciones quirúrgicas y los aspectos preoperatorios (clasificación de Shamblin, valor del estudio genético, el consentimiento informado, la utilidad de la embolización, etc.) inician la revisión. Los aspectos intraoperatorios (equipo quirúrgico) y de técnica quirúrgica (posición del paciente, incisión y exposición, control de los vasos e identificación de los nervios, la extirpación del tumor de manera subadventicial operiadventicial, la necesidad de resección arterial y su reconstrucción, etc.) son tratados en profundidad. Los aspectos postoperatorios, resultados de morbilidad (neurológica y vascular) y mortalidad, así como realizar el seguimiento de estos pacientes, finalizan la primera parte del artículo. La segunda parte se dedica a situaciones especiales del paraganglioma carotídeo (no resecable, maligno, residual [persistente] o recurrente, bilateral, múltiples y patologías asociadas, en niños, etc.). Finalmente, el último apartado, en forma de anexo, presenta las características y los resultados de nuestra serie (30 paragangliomas carotídeos en 26 pacientes, entre 1994 y 2008) (AU)

The present article reviews the current panorama of the surgical treatment of carotid paragangliomas. The article begins by discussing surgical indications and preoperative aspects (Shamblin’s classification, the value of genetic study, informed consent, the utility of embolization, etc).Intraoperative aspects (surgical team) and features of the surgical technique (the patient’s position, incision and exposition, vessel control and identification of nerves, subadventitialor periadventitial tumoral excision, the need for arterial resection and reconstruction, etc.) are discussed in depth. Postoperative aspects, morbidity (neurological and vascular) and mortality, as well as how to follow-up these patients, are discussed at the end of the first part of the article. The second part analyzes special situations concerning carotid paraganglioma (unresectable, malignant, residual [persistent] or recurrent, bilateral and multiple tumors, associated diseases, tumors in children, etc.). The final part of the article, in the form of an appendix, shows the characteristics and results of our series (30 carotid paragangliomas in 26 patients between 1994 and 2008) (AU)

Tumor de glomus carotídeo, a propósito de un caso / Carotid body tumor: a case report

Se presenta el caso clínico de un tumor de glomus carotídeo en una mujer de 27 años que debutó con un aumento de volumen cervical derecho. El estudio con tomografía computada en fase angiográfica (Angio TC) demostró un tumor heterogéneo a nivel de la bifurcación carotídea que provocaba efecto de masa desplazando, pero no infiltrando los vasos carotídeos. Se realizó la extirpación completa del tumor con diseccion subadventicial, durante la cual fue necesaria la ligadura de la arteria carótida externa distal al nacimiento de la arteria tiroídea superior. El informe histopatológico concluyó tumor de glomus carotídeo con áreas de necrosis y pleomorfismo celular. Se realizó una revisión de la literatura nacional e internacional sobre esta infrecuente enfermedad.

A importância da embolização pré-operatória no tratamento do tumor do corpo carotídeo: relato de caso e revisão da literatura / The importance of preoperative embolization for the treatment of the carotid body tumor: case report and review of the literature

Os tumores do corpo carotídeo são neoplasias raras, que se originam dos pequenos órgãos quimio e barorreceptores localizados na adventícia da bifurcação da artéria carótida comum. Constituem-se uma doença de grande interesse para o cirurgião vascular, na medida em que crescem aderidos à adventícia dos vasos que compõem essa bifurcação. Por isso, sua cirurgia requer não só o conhecimento anatômico da região, mas também perfeito reconhecimento das técnicas de reconstrução vascular. Representam um problema especial quanto a seu manejo, devido à sua rica vascularização e intimidade com estruturas nobres da região cervical, como nervos e grandes vasos. Neste caso, apresentamos um homem com um tumor de corpo carotídeo aderido à carótida direita, diagnosticado por punção biópsia e tratado em dois tempos, sendo o primeiro por tratamento endovascular, realizando embolização percutânea do tumor, e, no segundo, a ressecção cirúrgica do mesmo, o que evidencia o tratamento combinado, segundo atual literatura.

Carotid body tumors are rare neoplasms originating from the small chemo- and baroreceptors located in the adventitia of the common carotid artery bifurcation. They are a disease of great interest for vascular surgeons, given that they grow adhered to the adventitia of vessels comprising this bifurcation. For that, their surgery requires not only anatomical knowledge of the region, but also perfect familiarization with vascular repair techniques. Carotid body tumors are a particular problem as to their management, due to rich vascularization and intimacy with important structures of the cervical region, such as nerves and large vessels. We report on a male patient with carotid body tumor adhered to the right carotid artery, diagnosed by puncture biopsy and treated at two different time periods: first by endovascular treatment, with percutaneous embolization of the tumor; and later by surgical resection, which represents the combined treatment suggested in the current literature.

Carotid body tumors: objective criteria to predict the Shamblin group on MR imaging.

BACKGROUND AND PURPOSE: MR imaging is an established method for diagnosis and surgical planning of carotid body tumors (CBTs). However no studies have elaborated preoperative objective criteria to predict the Shamblin (surgical) classification of CBTs, an important predictor of vascular morbidity. The purpose of this study was to establish criteria to accurately predict the Shamblin group on preoperative MR imaging for a uniform reporting system. MATERIALS AND METHODS: MR images of 9 CBTs in 8 consecutive patients who underwent surgery between 2004 and 2007 were reviewed at a tertiary cancer hospital. The surgical records were blinded to the radiologists. A radiologic classification into 3 types (I, II, and III) based on the maximum degree of circumferential contact of the tumor with the internal carotid artery (ICA) was attempted and correlated with the Shamblin group in surgical records. RESULTS: There were 5 type III, 3 type II, and 1 type I tumors. The type I tumor had an ICA maximum circumference of contact less than or equal to 180 degrees , type II tumors had more than 180 degrees and less than 270 degrees , and type III tumors had a maximum circumference of contact of 270 degrees of more. MR imaging accurately predicted the Shamblin group in 8 (100%) of 8 operated tumors. Tumor size and Shamblin group did not have a uniformly predictable relation. CONCLUSIONS: Shamblin group can be predicted preoperatively on MR imaging, and the maximum degree of circumferential contact of the CBT with the ICA on axial images is the criterion to predict the Shamblin group.

Paragangliomas de cabeza y cuello / Parangangliomas of the head and neck

Los parangangliomas son tumores altamente vascularizados que se originan de células provenientes de la cresta neural. El tratamiento de elección es la resección quirúrgica completa, lo cual se ve dificultado por su abundante irrigación y por su estrecha relación anatómica con importantes estructuras vásculo-nerviosas. En el presente estudio se revisa retrospectivamenete la experiencia del Departamento de Otorrinolaringología de Clínica Las Condes en el manejo quirúrgico de estas neoplasias. Entre los años 1998 y 2003 se trataron 5 pacientes portadores de paragangliomas de cabeza y cuello: un glomus yugular (GY), 2 glomus carotídeo (GC) y 2 glomus timpánicos (GT). El estudio imagenológico consistió en tomografía computarizada (TC) para todos los casos, complementada con resonancia nuclear magnética (RNM) y/o angiografía en algunos pacientes. El abordaje quirúrgico fue el indicado para cada lesión: timpanotomía retroauricular (GT), cervicotomía (GC) y abordaje infratemporal tipo A de Fisch (GY). En todos se logró una resección tumoral completa, sin presentarse complicaciones perioperatorias de consideración ni recurrencias hasta la fecha. Contando con un adecuado estudio imagenológico y una cuidadosa planificación quirúrgica, la resección de los paragangliomas de cabeza y cuello puede realizarse con un bajo índice de complicaciones, reservando la radioterapia como alternativa terapéutica únicamente en aquellos casos inoperables.

Paragangliomas del cuerpo carotideo / Carotid body paragangliomas

Los paragangliomas son neoplasias derivadas de la cresta neural, benignas en un alto porcentaje y poco comunes. En la cabeza y cuello, los del cuerpo carotídeo, son los de mayor incidencia. Por lo general, se presentan como una masa asintomática y ocurren en personas entre la cuarta y quinta década de la vida. Su aparición se ha relacionado con la vida en las grandes alturas o con enfermedad pulmonar obstructiva crónica (hipoxia crónica), y existe un grupo con tendencia familiar. Las técnicas de imágenes diagnósticas no invasivas (resonancia magnética, tomografía computarizada, gammagrafía) son los instrumentos ideales para confirmar el diagnóstico. La cirugía se considera la única manera de tratamiento para lograr su curación. En grandes tumores, todavía existe morbilidad de tipo neurovascular durante la extirpación quirúrgica. Para reducir la misma, se ha preconizado la embolización arterial preoperatoria

Evaluation of topography and vascularization of cervical paragangliomas by magnetic resonance imaging and color duplex sonography.

The management of cervical paragangliomas (PGs) depends on their specific type and their relation to adjacent vessels. The purpose of this study was to evaluate the potential of magnetic resonance imaging (MRI) and color duplex sonography (CDS) to classify PGs according to topography and vascularization. Sixteen patients harboring 22 PGs were studied retrospectively. With digital subtraction angiography as reference, the topographic relation of the tumors to the carotid arteries and the internal jugular vein and the patterns of vascularization were assessed. On MRI and CDS the typical feature of 15 carotid PGs was splaying of the carotid bifurcation, with the external carotid displaced anteriorly and the internal carotid artery and internal jugular vein located posteriorly. In five vagal PGs both modalities showed unidirectional anterior displacement of the external and internal carotid arteries. Two jugular PGs were found to extend within the lumen of the internal jugular vein. CDS completely depicted carotid body tumors but failed to delineate the high cervical portion of vagal and jugular PGs. MRI allowed us to assess the entire extent of all PGs. Nineteen lesions showed flow voids corresponding to abundant flow signal on CDS: three carotid body tumors appeared hypovascular on CDS and MRI. On CDS, intratumoral flow was directed cranially in carotid and inferiorly in vagal and jugular PGs. CDS and MRI are suitable for classification of cervical PGs as carotid, vagal or jugular PGs based on the topographic relation to the carotid arteries and internal jugular vein. Visualization of the intrinsic tumor vasculature proved an additional distinguishing criterion on CDS.

Tratamiento quirúrgico de las lesiones carotídeas / Surgical treatment for carotid lesions

Se presenta una serie de 98 cirugías carotídeas, 93 endarterectomías y cinco resecciones de tumores del cuerpo carotídeo. La serie de 93 endarterectomías se comparó con dos informes recientes de la literatura; se analizaron 16 variables y se obtuvo una correlación estadística mediante la t de Student en cada una de ellas. Se encontraron diferencias estadísticamente significativas en: número de enfermos y tipo de seguimiento, indicaciones quirúrgicas (en nuestra serie más de 90 por ciento de las operaciones se efectuaron en enfermos con lesiones sintomáticas, en comparación con lo informado, en donde hubo 40 por ciento de enfermos con lesiones asintomáticas). En nuestra serie se utilizó una derivación, selectiva. Las cifras de morbimortalidad y los resultados a largo plazo fueron similares con otros estudios revisados. En la discusión se analiza la literatura reciente al respecto. Los tumores del cuerpo carotídeo, aunque poco frecuentes, constituyen un reto para su tratamiento. Se discute la técnica quirúrgica utilizada (resección subadventicia), ya que ésta simplifica su resección y disminuye el porcentaje de complicaciones