Carotid Body Paraganglioma Research Articles

Update in the classification and the role of intra‐arterial stenting in the management of carotid body paragangliomas

To review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra-arterial stenting in their surgical management. Retrospective case series of 20 patients with 28 CBPs that were surgically resected at our center. Intra-arterial stenting was performed in Shamblin II and II classes. The mean follow-up was 47.8 months. Five (17.9%) tumors were Shamblin class I, 15 (53.6%) were class II, and 8 (28.6%) were class III. Thirteen (68.4%) CBPs were associated with other paragangliomas. The internal carotid artery (ICA) was stented preoperatively in eight (28.6%) cases and occluded in four (14.3%) cases. The tumor extended to the jugular foramen in six cases (21.4%). Intraoperatively, there was an ICA injury in one case of Shamblin II CBP in the present era. The proposed classification enables the clinician to plan the management of the ICA and the right approach. Stenting of the ICA gives a chance for complete tumor removal with arterial preservation.

Carotid body paragangliomas – clinical variety and management (RCD code: I-O)

Paragangliomas (PGLs) are a group of rare, slow-growing tumours which are found between the base of the skull and the pelvis. The tumour may be asymptomatic, although a lump on the neck, cranial nerve palsy, or neck pain may be present. The treatment of choice is surgical resection. We present the cases of 7 patients (6 females) diagnosed with 9 PGLs of the carotid body (carotid body tumours – CBTs). These include: one case with known genetic burden, one of an advanced bilateral and recurrent tumour, and one with a malignant tumour. All presented CBTs were surgically removed. The size of a tumour correlates with postoperative complications. Resection of the largest lesion was associated with persistent left recurrent laryngeal, hypoglossal, and partial facial nerve paralysis. Other complications included single cranial nerve palsy and temporary Horner syndrome. JRCD 2018; 4 (1): 9-14.

A Hybrid Approach Towards Successful Resection of a Huge Carotid Body Paraganglioma Using Coil Embolization and Traditional Surgical Techniques.

Carotid Body Paraganglioma (CBPGL), is a type of neuroendocrine tumor that should be managed promptly due to their malignant potential and locally aggressive nature making resection at a later stage difficult. The objective of this case report is to explore the benefit of coil embolization and describe the surgical techniques employed in successful resection of a huge CBPGL.

DON’T FORGET TO BREATHE: A CASE OF HYPOXEMIA AFTER CAROTID BODY RESECTION

SESSION TITLE: Pulmonary Physiology SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Carotid body tumors (CBTs) are paragangliomas, slow-growing neuroendocrine tumors that secrete catecholamines. Management involves surgical resection or radiation. Although chronic hypoxia has been identified after resection of these tumors, the effects of altitude on oxygenation in these patients has not been well-described. We present a case of chronic hypoxia in a patient after bilateral CBT resection. CASE PRESENTATION: A 72 year-old male with a personal and family history of bilateral CBTs presented for evaluation of hypoxia. He underwent resection of these tumors one year prior to presentation. Final tissue exam identified benign carotid body paragangliomas. He had a significant history of tobacco use but had quit 5 years prior. Given his new hypoxia, he underwent evaluation for COPD. Review of systems was notable for dyspnea with heavy exertion but he was otherwise without respiratory complaints. He lived at 1200m above sea level without significant dyspnea, but frequently traveled to 2500m above sea level where his dyspnea would worsen. On exam his baseline SpO2 was 90-91%, but increased quickly to 97-98% with frequent deep breaths. Due to concern for COPD, pulmonary function testing (PFT), plethysmography and DLCO were obtained and all normal. 6MWT was significant for desaturations that improved with 2-3L/min of supplemental O2. ABG showed minimal hypoventilation with a PaCO2 42mm Hg at rest. Overnight oximetry showed mild sustained hypoxemia. CT chest, PET and a V/Q scan were obtained and were all unremarkable. The patient was started on 2-3L/min of supplemental O2 with ambulation and sleep. At one year follow-up he reported control of his dyspnea even at high altitudes. DISCUSSION: The effects of ventilatory control in patients after bilateral carotid-body resection has been previously described. It is theorized that the carotid bodies are responsible for the hyperpnea that results from hypoxia; the aortic chemoreceptors to a much lesser extent. Brainstem respiratory centers receive afferent impulses from the carotid bodies during hypoxia and hypercapnia to control ventilation by increasing MV. In those who have undergone bilateral carotid body resection, there is minimal to no change in MV during hypoxia. At altitudes higher than 2000m the atmospheric O2 pressure decreases causing chronic hypoxia. This case demonstrates the effects of this reduced atmospheric O2 pressure in a patient that has undergone a bilateral carotid body resection. CONCLUSIONS: Providers should be aware that in patients who have undergone carotid body resection, regulatory control of ventilation is impaired, resulting in diminished increase in MV response to hypoxia. At higher altitudes, this becomes clinically significant due to the reduced atmospheric O2 pressure inspired. Patients with hypoxia after bilateral carotid body resections should be advised to use supplementary O2, especially at high altitudes. Reference #1: Erickson et al. “Benign Paragangliomas.” J Clin Endocrinol Metab. 2001 Nov; 86 (11): 5210-5216. Reference #2: Lugliani et al. “Effect of bilateral carotid-body resection on ventilatory control at rest and during exercise in man,” The New England Journal of Medicine. 1971; 285 (20):1105–1111. Reference #3: Rodríguez-Cuevas et al. "Carotid body tumors in inhabitants of altitudes higher than 2000 meters above sea level.” Head & Neck. 1998; 20:374-378. DISCLOSURES: No relevant relationships by David Dorsey, source=Web Response No relevant relationships by Brian Foster, source=Web Response

Cervical paragangliomas: experience of 114 cases in 14 years

Introduction and objectiveTo report a single center experience with carotid body paraganglioma cases that were treated by the same surgeon in a city with high prevalence of paragangliomas due to high altitude. MethodsWe retrospectively investigated the demographic, clinicopathological and radiological data of 104 patients diagnosed with cervical paragangliomas between 2003 and 2017. The patients were classified according to the Shamblin classification. ResultsIn this study a total of 104 patients (33 male and 71 female, with a mean age of 54.6±13 years) diagnosed with cervical paragangliomas located on carotid bifurcation between 2003 and 2017 were included. Among those patients, 10 presented with bilateral tumors and in total, 114 paragangliomas were managed in this period. The mean diameter of the tumors was 5.12±1.45cm. Malignant tumor was determined in only one (0.9%) patient. All patients were operated. In 12 patients with the tumor diameter larger than 5cm, preoperative coil embolization was achieved. In 14 patients, preoperative angiographic embolization was employed and in 4 patients intraoperative sclerosing agent injections were performed. Facial paralysis was observed in 2 patients and dysphagia was present in 1 patient, Horner syndrome was seen in 1 patient and hoarseness was reported in 7 patients after operation. All those complications improved during follow-up. Mortality was not reported in any cases. ConclusionSurgery is the definitive treatment for patients with cervical paragangliomas. Although, it may be difficult in patients with the advanced Shamblin types, in experienced hands, complication rates are very low.

A meta-analysis on the surgical management of paraganglioma of the carotid body per Shamblin class.

The aim of this study was to evaluate the risk associated with different types of surgery for carotid body paraganglioma of different Shamblin class. A meta-analysis was conducted to evaluate per tumour class, the local control, cranial nerve damage and complication rates of different techniques using internal carotid artery (ICA) and external carotid artery (ECA) ligation, clamping or bypassing, as well as the craniocaudal vs caudocranial techniques. A meta-analysis is conducted after a systematic search in PubMed and the Cochrane library, in accordance with the PRISMA guidelines. Local control, cranial nerve damage, complications, function recovery. Out of 3565 articles, 27 were selected. The overall quality of evidence of studies was low. Cranial nerve damage (3%, 17% and 39%) and complication rates (0%, 1% and 10%) were significantly related to Shamblin class (class 1, 2 and 3, respectively, P<.01). For class 3 tumours, an increased risk of complications was found associated with routine ICA manipulation/reconstruction (RR 3.12 with a 95% CI of 1.29-7.59), as well as a trend towards enhanced risk of routine ECA ligation (RR 3.48 with a 95% CI of 0.88-13.81). For class 1 and 2 tumours, surgery seems a viable treatment option. For class 3 tumours, morbidity in terms of cranial nerve deficit and complications is considerable; particularly, the use of ICA manipulation/reconstruction and potentially ECA ligation seem to be accompanied by high stroke incidence.

Paraganglioma Invasor, Produtor de Metanefrinas e Indutor de Síncopes Progressivas

Introdução: Paragangliomas são tumores raros, vasculares e predominantemente benignos, de origem embriológica da crista neural. Em sua grande maioria são assintomáticos e, quando acometem a cabeça e pescoço, o local mais comum é o corpo carotídeo. Raramente podem induzir síncopes, invadir vasos adjacentes e produzir metanefrinas. Caso Clínico: Mulher com 26 anos e síncopes progressivas há dois anos, com frequência crescente até dois episódios diários, associados a bradicardia e hipotensão. Foi diagnosticado paraganglioma carotídeo invasivo e produtor de metanefrinas. A exérese do paraganglioma controlou as crises e resultou em um retorno aos níveis basais de metanefrinas. Após dois anos de seguimento a paciente encontra-se assintomática. Discussão: Neste caso foi apresentado um tumor de seio carotídeo raro, de crescimento lento, que se apresentou clinicamente com síncopes progressivas, de características reflexas, neuro-mediadas, pela compressão do seio carotídeo e de forma atípica, pela produção de metanefrinas. As características deste tumor foram revistas, assim como seus fenômenos fisiopatológicos peculiares e suas recomendações de acompanhamento pós-operatório, embasados nos Guidelines europeus atuais. Conclusão: Paragangliomas de corpo carotídeo, que são considerados tumores raros, podem apresentar-se com características ainda mais incomuns, necessitando, como neste caso, de um conhecimento mais apurado sobre síncopes e paragangliomas. A definição de síncopes progressivas é inexistente na literatura científica atual, podendo ser classificadas como um grupo à parte, merecendo abordagem diagnóstica efetiva mais precocemente, associada a desfechos com menor risco, mais breves e favoráveis.

Presentation with Personality changes and Tinnitus to a Vascular Intervention: Rare case of Carotid Body Paraganglioma

Background: Carotid body paragangliomas are rare neuroendocrine neoplasms of chromaffin negative glomus cells. This case report explains an atypical case with unusual presentation and treatment.&#x0D; Case Report: A healthy smoker technician by profession was brought to the emergency room (ER) with coprolalia. The general physical exam did not reveal any information. His history revealed unilateral tinnitus and odynophagia leading to a consultation by the neurologist with head imaging. Acoustic neuroma was ruled out and the caregiver was asked to elaborate the events mentioned in the history and a psychiatric examination was done. The personality changes were evaluated by the psychiatrist that showed overlapping of delirium and depression. The patient was further examined by a vascular surgeon. After careful revisiting of the history, examination and indication of tender mass in the neck by the patient's vascular surgeon, the diagnosis of carotid body paraganglioma was made which was followed by surgical resection for treatment.&#x0D; Conclusion: Carotid Body Paragangliomas are very vascular structures and their manipulation in a surgery setting requires expertise. This case presented with personality changes and tinnitus, a very less likely event to occur in a carotid body tumor. The present care report, thus adds on to the literature of carotid body tumors and its presenting symptoms.

68Ga-DOTATATE PET-CT imaging in carotid body paragangliomas.

The aim of this study was to present our experience in the baseline evaluation of carotid body paragangliomas (CBP) with 68Ga-DOTATATE PET-CT. Five patients (4F, 1M; age 24-73years) with CBPs who underwent 68Ga-DOTATATE PET-CT scan before the treatment were evaluated retrospectively. PET-CT images were analyzed visually as well as semiquantitatively, with measurement of maximum standardized uptake value (SUVmax). All patients had unilateral CBP lesion, showed intense 68Ga-DOTATATE uptake in PET-CT. Additionally, 68Ga-DOTATATE avid lesions were found in two patients. One of them had focal intense uptake in thyroid gland and frontal cerebrum. The other one had intense uptake in bone and adrenal mass. Four patients were operated for unilateral primary CBP. Last patient was treated with peptide receptor radionuclide therapy (177Lu-DOTATATE) for both metastatic pheochromocytoma and CBP. 68Ga-DOTATATE PET-CT is a valuable imaging modality for staging of CBPs, detecting unknown lesions and changing the management of patients. It is also useful in demonstrating expression of SSTRs for PRRT opportunity.

Carotid body paraganglioma: a rare pathology but not to be forgotten

Carotid body paraganglioma: a rare pathology but not to be forgotten

A novel succinate dehydrogenase subunit B germline variant associated with head and neck paraganglioma in a Dutch kindred: A family-based study.

In the Netherlands, the majority of hereditary head and neck paragangliomas (HNPGL) are caused by germline variants in the succinate dehydrogenase genes (SDHD, SDHB, SDHAF2). Here, we evaluate a four-generation family linked to a novel SDHB gene variant with the manifestation of a HNPGL. A family-based study. The VU University Medical Center (VUmc) Amsterdam, a tertiary clinic for Otolaryngology and Head and Neck Surgery. The index patients presented with an embryonic rhabdomyosarcoma and a non-Hodgkin lymphoma. Array-based comparative genomic hybridisation (aCGH) analysis and multiplex ligation-dependent probe amplification (MLPA) revealed a novel deletion of exon 1-3 in the SDHB gene, suspected to predispose to paraganglioma (PGL)/pheochromocytoma (PHEO) syndrome type 4. Subsequently, genetic counselling and DNA testing were offered to all family members at risk. Individuals that tested positive for this novel SDHB gene variant were counselled and additional clinical evaluation was offered for the identification of HNPGL and/or PHEO. The DNA of 18 family members was tested, resulting in the identification of 10 carriers of the exon 1-3 deletion in the SDHB gene. One carrier was diagnosed with a carotid body PGL and serum catecholamine excess, which was surgically excised. Negative SDHB immunostaining of the carotid body tumour confirmed that it was caused by the SDHB variant. The remaining 9 carriers showed no evidence of PGL/PHEO. Deletion of exon 1-3 in the SDHB gene is a novel germline variant associated with the formation of hereditary HNPGL.

Age and Tumor Volume Predict Growth of Carotid and Vagal Body Paragangliomas.

Objective Treatment for head and neck paragangliomas (HNGPL) can be more harmful than the disease. After diagnosis, an initial period of surveillance is often indicated, and surgery or radiotherapy is reserved for progressive disease. With the aim to optimize this "wait and scan" strategy, we studied growth and possible predictors. Design A retrospective cohort study was conducted. Setting This study was conducted at a tertiary referral center for patients with HNGPL. Methods Tumor volume was estimated for 184 SDHD -related carotid and vagal body paragangliomas using sequential magnetic resonance imaging. Cox regression was used to study predictors of tumor growth. Results The estimated fraction of growing tumors ranged from 0.42 after 1 year of follow-up to 0.85 after 11 years. A median growth rate of 10.4 and 12.0% per year was observed for carotid and vagal body tumors, respectively. Tumor location, initial volume, and age ( p < 0.05) were included in our prediction model. The probability of growth decreased with increasing age and volume, indicating a decelerating growth pattern. Conclusions We created a prediction model (available online), enabling a more individualized "wait and scan" strategy. The favorable natural course of carotid and vagal body paragangliomas was confirmed; although with long follow-up growth will be observed in most cases.

Robotic radiosurgery of head and neck paragangliomas: a single institution experience.

CyberKnife® is a robotic stereotactic radiotherapy system. The aim of this study is to evaluate the effectiveness and the safety of CyberKnife® on treating head and neck paragangliomas and to report our results. Between March 2009 and June 2014, 12 patients with head and neck paragangliomas have been referred to our clinic: in three cases had jugular paragangliomas, five cases had carotid body paragangliomas and three cases had tympanic paragangliomas. One patient had bilateral neck paragangliomas (right neck; carotid body paraganglioma, left neck; jugular pargangliomas). All of them received fractionated stereotactic radiotherapy with CyberKnife® up to a total median dose of 24 Gy (reference isodose 67-90%). The median tumor volume was 35.5 cc (range, 5.3-113.8 cc). The median follow up was 30 months (range, 0-66 months). Local tumor control was assessed according to RECIST criteria on follow-up imaging studies. There were no acute or late toxicity related with stereotactic radiotherapy after treatment. No local tumor progression was observed on magnetic resonance imaging and none of our patients showed progressive clinical status. Seven tumors shrinked in size (54%). Five tumors (46%) had stable size during follow up. Local control rate was 100%. Stereotactic radiotherapy is a good alternative to surgery for the treatment of head and neck paragangliomas coming up with a clear benefit of acute and late side effects. CyberKnife® seems to be a safe and efficient system treating head and neck paragangliomas.

Paragangliomas carotídeos: hacia un tratamiento personalizado que reduzca la morbilidad

Carotid body paragangliomas (CBP) are uncommon tumours that very rarely cause death. The genetic basis of tumours of hereditary origin (more than a third of the total) has been determined in the last few years, which has helped to identify the population at risk and to implement screening methods for an early diagnosis of tumours. The most common treatment of CBP has been surgery, which frequently causes significant morbidity. A significant number of paragangliomas do not experience any growth, which justifies a wait-and-see approach using annual image studies. Those tumours with significant growth must be treated. Radiotherapy has similar outcomes to surgery and has no neurological or vascular sequelae. However, surgery is indicated in Shamblin I/II carotid body tumours in young patients, in the rare malignant or hyper-functioning tumours, and in the failure of radiotherapy. Multiple tumours of familial origin should be treated conservatively.

Carotid Body Tumor With Malignant Behavior in a Patient in His Eighth Decade

Carotid body tumors (CBTs) are rare neoplasms with rare malignant potential. These tumors are usually parasympathetic ganglia-derived lesions which located in the neck at the bifurcation of the external and internal carotid arteries. In contrary to sympathetic-derived tumors, they are often non-secretory. However, about 5% of these tumors may still secrete some of the catecholamine-related compounds. Most of these lesions are diagnosed in the third to fifth decades of life, with more cases revealed during autopsy examinations. Although it is considered a disease of middle age, elderly people are not immune. We report a case of an elderly patient in his eighth decade, who presented with a mass-like lesion in the right side of his neck during routine medical examination. Imaging study showed an enhancing mass in the carotid artery bifurcation with pressure effect and lymphadenopathy. The patient underwent surgery and tumor was removed uneventfully. The pathology report later confirmed oval-shaped cells with positive neuroendocrine markers consistent with carotid body paraganglioma. We believe these tumors are overlooked and yet may be missed without proper medical examination. We report this case for two reasons, being a very rare tumor with malignant potential in an elderly patient and to raise the awareness among medical practitioners. J Med Cases. 2017;8(10):311-314 doi: https://doi.org/10.14740/jmc2906w

Paragangliomas of the head and neck region: A single center experience

Background: Head and neck paragangliomas are slowly growing, highly vascular, mostly benign tumors that commonly occur at the carotid bifurcation at the jugular bulb, in the tympanic cavity, or as vagal paragangliomas. Unlike the adrenal counterpart, a vast majority of them are nonsecretory. Aims and Objectives: To study the clinicopathological aspects of paragangliomas arising in the head and neck region. Materials and Methods: This study was conducted in a tertiary care centre for head and neck diseases between 2008 and 2016. Clinical data were retrieved from the records. Morphological examination was the mainstay of diagnosis. Results: Twenty-three cases of head and neck paragangliomas were diagnosed by morphological examination. Paragangliomas constituted 0.20% of all head and neck lesions. The age group ranged between 18 and 60 years, with a mean age of 44 years. Most common age at presentation was fourth and fifth decades. Majority of cases occurred in females, with male: female ratio of 1:4. Out of 23 cases, 19 cases (82.60%) involved the jugulotympanic region, 2 cases (8.69%) were laryngeal paragangliomas, and 2 cases (8.69%) were carotid body paragangliomas. Conclusion: Paragangliomas of the head and neck are uncommon lesions. The most common site in the head and neck region was the jugulotympanic region. Most cases of jugulotympanic paraganglioma presented in the fifth decade and later. Laryngeal paraganglioma presented clinically earlier in the second decade. Jugulotympanic and laryngeal paraganglioma showed dominance of tumor vasculature histologically. There was a rare case of laryngeal paraganglioma with lateral neck extension in this study.

Diagnostic and Therapeutic Difficulties in Carotid Body Paragangliomas, Based on Clinical Experience and a Review of the Literature.

Paragangliomas are rare neuroendocrine tumors, representing 0.03% of all tumors. Half of them develop in the head and neck, and among these 50% are sporadic cervical tumors. The aim of the study was to carry out an epidemiological and clinical analysis of paraganglioma patients diagnosed and treated at the authors' clinics between 1985 and 2014. The medical data of 47 patients were analyzed. All the patients were qualified for surgery. In 43 cases (88%), simple resection of the tumor was performed, including 11 cases (22%) that additionally required vascular suturing, and 5 (10%) that required reconstruction of the internal carotid artery. Carotid vessel repair was performed by shortening the internal carotid artery in 3 cases (6%), using a saphenous vein graft in 2 cases (4%), and by creating an anastomosis between the external carotid artery and the distal portion of the internal carotid artery in one case (2%). In 40 cases (82%), the course of treatment was uneventful. Three patients (6%) were reoperated because of symptoms of cerebral stroke. Palsy of the hypoglossal nerve occurred in 3 cases (6%), and facial nerve palsy in 2 patients (4%). Six patients (12%) developed postoperative hematomas in the wound. In all the cases, histopathological examinations confirmed carotid paraganglioma. Cooperation with an otolaryngologist and vascular surgeon during surgery is recommended due to frequent damage to carotid vessels by carotid paragangliomas. Detection of the tumor in the early stages improves surgical treatment outcomes and reduces the number of complications. Regular postoperative check-ups are necessary due to possible occurrences of multiple tumors.

The Double Mandibular Osteotomy for Vascular and Tumor Surgery of the Parapharyngeal Space

The purposes of this study are to describe our experience using a double mandibular osteotomy for access to the parapharyngeal space in vascular and tumor surgery and to report on the outcomes and complications of this procedure. We designed and implemented a case series to review the medical records of all patients treated with a double mandibular osteotomy for parapharyngeal space access from 1994 to 2016. Patient demographic characteristics, indications for the procedure, outcomes, and complications were recorded. A total of 17 patients underwent a double mandibular osteotomy procedure for access to the parapharyngeal space during the study period. There were 7 men (41%) and 10 women (59%) comprising the cohort. The average age was 57years (range, 29 to 75years). The follow-up period ranged from 6 to 98months (mean, 40months), and 7 patients (41%) were tobacco users at the time of surgery. The most common indication was high internal carotid artery stenosis (n= 6) followed by carotid body paraganglioma (n= 3). Average blood loss was 186mL, and there were no deaths during the study period. Eight postoperative complications were noted in 7 patients (41%). No procedures were aborted or compromised because of inadequate parapharyngeal space access. All patients showed clinical and radiographic signs of healing of the osteotomy sites. The double mandibular osteotomy provides adequate access to the parapharyngeal space for effective tumor removal and high carotid surgical intervention with acceptable patient morbidity and complications.

Percutaneous Phil™-Embolization for Preoperative Therapy of Carotid Body Paragangliomas

Introduction: Paragangliomas are rare tumors representing a therapeutic challenge. In particular, the surgical removal may lead to life-threatening bleeding. The preoperative percutaneous embolization is an alternative that allows a high closure rate of tumor-feeding vessels in a short intervention time and thus significantly reduces intraoperative bleeding probability. Complete tumor resection is facilitated thereby. The use of a new non-adhesive liquid embolic agent is presented here. Methods: A 50-year old patient presented with 4 cm large paraganglioma of the carotid body (Shamblin II). A percutaneous embolization with 7 ml PHIL™ (injectable precipitating hydrophobic liquid) was performed preoperatively. 24 h later the complete surgical resection of the tumor was performed. Results: A good distribution of the liquid embolic agent could be achieved over the entire tumor. Intraoperative resection of the tumor was much easier and faster due to low bleeding tendency over the entire surface of the tumor. Total blood loss was less than 50 ml. All adjacent nerve and arterial structures could be spared. Postoperative nerve function was normal and the patient was discharged on the 4th postoperative day. Conclusion: The combination of percutaneous embolization and surgical resection provides a safe combination in the treatment of advanced carotid body paragangliomas. The use of a novel liquid embolic agent may possibly further optimize the therapy.

Neurovascular complications following carotid body paraganglioma resection

ObjectiveThe present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications. Material and methodsA retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (<1month) and late (18 months) postoperative neurovascular complications. ResultsEarly postoperative complications occurred in 31 cases, including 30 cases of cranial nerve deficit (56%). Cranial nerve deficit occurred in 83% of Shamblin III carotid body paragangliomas and was associated with significantly larger mean tumor size (4±1.4cm versus 2.9±1.3cm; P<0.01). Shamblin III tumor and tumor size>3.2cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months’ follow-up; no predictive factors could be identified for this. ConclusionSurgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications.