Vanderbilt’s Experience with 201 Carotid Body Tumors

Abstract

Objective: To discuss the evolving treatment considerations of carotid body tumors (CBT) based on a large cohort. Method: A retrospective review of 149 patients with 201 CBT treated at Vanderbilt University’s Dept. of Otolaryngology over a 25-year period (1986-2011). Patients were analyzed for preoperative deficits, familial involvement, progression under observation, operative details, and postoperative sequelae. Results: Bilateral CBTs were identified in 44%, associated vagal paragangliomas in 26%, and jugular tumors in 22% of patients. Familial inheritance was noted in 35%. A total of 163 tumors were resected from 139 patients. Preoperative embolization was utilized in 33% of tumors. Internal carotid resection-reconstruction was performed in 13%. No postoperative strokes occurred. Postoperative cranial nerve dysfunction was rare. Of patients who underwent staged resection of bilateral CBTs, 73% experienced baroreflex failure. Although transient mild first bite syndrome was common, only 30% of patients had ongoing significant symptoms. No recurrence has been noted from the CBTs resected at Vanderbilt. Conclusion: Management of CBTs requires consideration of familial inheritance and potential for multiple paraganglioma. We believe the primary treatment of CBT should remain surgical resection, which can be performed with curative intent with minimal morbidity. Slow growth patterns in paragangliomas makes temporary or long-term observation a treatment option in selected patients.