Pre-Operative Embolisation In Surgical Carotid Body Tumour Resection: Is It Really Useful?

Abstract

Objective: Carotid body tumour (CBT) is the most common tumour in the family of head and neck paragangliomas, making up approximately 60 – 70% of them. They are typically diagnosed in the fourth to fifth decades with a female predilection. CBT present as soft tissue density on non-contrast CT and complete transfemoral angiography is considered the “gold standard” when establishing diagnosis of CBT with a 100% accuracy. Primary treatment consists of surgical resection to reduce tumour mass size and to decrease surgical risks associated with resection of these highly vascularised tumours, pre-operative embolisation of CBT has been proposed in the literature with varying results. There are no universal guidelines regarding pre-operative CBT embolisation and performance is mostly guided by preference of the surgeon and tumour size. The decision to perform pre-operative embolisation, usually 24 – 48 hours before surgery (though timing of surgical CBT resection following prior embolisation varies between 1 and 14 days post embolisation), is largely dependent on tumour size. Embolisation can be done via a transfemoral arterial route, or percutaneous (direct intralesional) route. The aim of this study was to investigate the efficacy of pre-operative embolisation prior to surgical CBT resection regarding intra-operative blood loss, operative time, length of hospital stay, and peri-operative complications (e.g., transient or ischaemic cerebrovascular event, vascular injury, or cranial nerve injury).