Perioperative Approach in the Surgical Management of Carotid Body Tumors

Abstract

To the Editor: In their recent article, Zhang et al. described their experience with surgical treatment of carotid body tumors (CBTs) using preoperative embolization. We appreciate their interesting work and we are especially pleased by the very low perioperative neurologic morbidity (only 3 cases of lesions of the hypoglossal nerve). We agree with the selective use of preoperative embolization (only Shamblin III or large paragangliomas), which may also simplify the operative procedure and reduce blood loss, although it will not decrease rates of cranial nerve injury. Despite the promising findings, we have some observations and some questions relative to the preoperative management of patients with CBTs. In all cases, Zhang and colleagues used computed tomography (CT), ultrasonography, and/or magnetic resonance imaging (MRI) to delineate the CBT, and digital subtraction carotid angiography (DSA) in those cases scheduled for endovascular preoperative embolization. Only a minority of CBTs (1e3%) demonstrate clinical evidence of hormonal activity. Approximately 10e15% of CBTs cases are familial. The occurrence of malignancy is also significantly different in sporadic and familial cases. Its overall frequency is reported to be 6% for CBTs. Multicentricity of paragangliomas can occur in up to 25% of patients. Accordingly, the modern approach to