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Abstract
Herein we report the management of a giant, high-grade and vascular carotid body tumor in a young woman. She presented with slowly progressive neck swelling. Vascular imaging revealed a left-sided, high-grade giant carotid body tumor (> 8cm). The tumor was completely excised by caudocranial subadventitial dissection. Histology of the tumor revealed a characteristic Zellballen pattern of the lesion, suggestive of a paraganglioma. The patient made an uneventful recovery. We also discuss newer insights regarding the management of such highly vascular lesions.
Highlights
We report the management strategy for a similar case, where caudocranial subadventitial dissection completely excised this tumor, one of the largest reported in the literature[1,2]
Internal carotid artery ligation with reconstruction requirements as well as permanent cranial nerve deficits have been observed in 23% of cases, all belonging to Shambling grade 3 tumors[30]
Large and complicated vascular tumors can be managed with proper planning and execution[36]
Summary
Management of such highly vascular lesions, which completely encase the major carotid artery along with its branches, is even more challenging. Case report A 22-year-old woman presented to the Neurosurgery clinic in Nobel Teaching Hospital with a history of slow progressive but painless swelling over her left neck, ongoing for the last 6 months She was experiencing some difficulty while swallowing. The patient underwent a CT angiography, which revealed a well-defined large (> 8 cm) heterogeneous and hyperdense soft tissue lesion; showing intense arterial enhancement at the level of carotid bifurcation (Figure 1). The lesion was getting vascular supply from both the ICA and ECA branches (Figure 3) These findings were all highly suggestive of a carotid body tumor.
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