Elsevier

Surgery

Volume 169, Issue 3, March 2021, Pages 700-704
Surgery

Transplant and Vascular
Contemporary management of carotid body tumors in a Midwestern academic center

Selected to be presented at the 77th Central Surgical Association Meeting in June 2020 in Milwaukee, WI.
https://doi.org/10.1016/j.surg.2020.07.030Get rights and content

Abstract

Background

Carotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection.

Methods

A single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX).

Results

Among 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21–79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm3 vs 205 cm3, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1–9 days). At a mean follow-up of 12 months (range 1–63 months), there has been no recurrence.

Conclusion

Although carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.

Introduction

Carotid body tumors (CBT) are rare, slow growing, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body.1 They are the most common paraganglioma of the head and neck, constituting 60% to 70% of these tumors.2 Although usually a hormonally inactive asymptomatic mass, occasionally localized pain or cranial nerve dysfunction may be a manifestation given the close proximity of the mass to cranial nerves IX, X, and XII.3 On physical exam, a CBT is a firm, rubbery mass that is mobile horizontally but not vertically. Surgical resection is the mainstay of treatment, though observation may be considered in elderly or high-surgical-risk patients, given the very slow growth of these tumors and low risk of malignancy.4,2 Owing to the hypervascular nature of these tumors and intimate association with the carotid arteries and cranial nerves, meticulous surgical techniques are paramount to successful en bloc resection. Thus, the objective is complete resection with minimal perioperative cranial nerve injury or ischemic stroke complications. In this report, we focus on a single-center experience in managing these uncommon tumors through a multidisciplinary approach, using specific surgical techniques rendering excellent outcomes.

Section snippets

Methods

After Institutional Review Board approval, a single-center, retrospective chart review was performed for all patients who underwent complete excision of a carotid body tumor at Northwestern Memorial Hospital from 2002 to 2019. All patients underwent preoperative imaging with a contrast-enhanced computed tomography (CT) scan, magnetic resonance imaging (MRI), carotid duplex, or some combination thereof (Fig 1). Operative planning including whether or not to perform preoperative embolization,

Results

Among the 25 patients who underwent surgical resection, 64% (n = 16) were women (see Table I). There were 21 patients (84%) who were asymptomatic, and the mean age was 49 years (range 21–79). All of the tumors were hormonally inactive, the mean size was 3.3 centimeters (range 1.5–8.9 cm), and the Shamblin class distribution went as follows: 16% type I (n = 4), 40% (n = 10) type II, and 44% (n = 11) type III. Men were found to have significantly larger tumors on presentation (4.1 cm vs 2.8 cm, P

Discussion

First described by Albrecht Von Haller in 1743, CBTs are typically situated in the adventitia of the carotid bifurcation and are highly vascular.5 There are 3 types of CBTs: sporadic, which is the most common; familial, which is more common in younger patients; and hyperplastic.5 The hyperplastic type is frequently associated with living at high elevation, as chronic hypoxic conditions including cyanotic heart disease and chronic obstructive pulmonary disease can lead to hypertrophy,

Conflict of interest/Disclosure

Dr. Eskandari has received honoraria from Silk Road Medical, Inc for service on the Roadster clinical events committee; and from W. L. Gore & Associates as a TEVAR course director. Author CLF is partially supported by a National Institutes of Health Grant (2T32HL094293–06). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding/ Support

Author CLF and research reported in this work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health in the form of partial stipend support under Award Number T32HL094293 and The Abbott Fund, Abbott Cardiovascular Fellowship. The funding sources had no role in the study design, collection/analysis/interpretation of data, writing of the report, nor the decision to submit for publication. The content is solely the responsibility of the authors and does

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