Management Of Carotid Body Tumors Research Articles

Perioperative strategies in the management of carotid body tumors

Despite the availability of noninvasive neuroradiographic techniques for the evaluation of head and neck neoplasms, paragangliomas of the carotid body often achieve substantial size before definitive diagnosis. Surgical "exploration" for the attempted resection of these lesions often results in significant blood loss, inadvertent cranial nerve injury, and procedure abandonment with partial tumor removal. Sixteen carotid body tumors were surgically resected at our institution between July 1988 and January 1995. Four of these patients had undergone cytologic examination by fine-needle aspiration (FNA) and another 6 patients underwent failed attempted resection of their lesions as the result of intraoperative hemorrhage. Of the remaining 6 patients referred for the first time evaluation of a "neck mass," the diagnosis was made by patient history, physical examination, magnetic resonance imaging, or magnetic resonance angiography. Complete tumor removal was accomplished in all 16 patients using a variety of lateral transcervical and skull base approaches. This article focuses on the clinicoradiographic diagnosis of carotid body tumors that do not need preoperative histologic confirmation. Specific intraoperative techniques for tumor removal, carotid artery management, and cranial nerve preservation are demonstrated through case presentations. Perioperative morbidity and overall results are detailed for this series of patients.

An Evaluation of Color Duplex Scanning in the Primary Diagnosis and Management of Carotid Body Tumors

Carotid body tumors present a diagnostic challenge. Despite technologic diagnostic advances, misdiagnosis resulting in blind biopsy or exploration through a limited incision still occur. Color duplex scanning has recently been used to evaluate carotid body tumors in our institution. A characteristic feature of these tumors found with this modality is wide splaying of the carotid bifurcation by a hypervascular mass. Color duplex scanning is the noninvasive modality of choice for the primary diagnosis of carotid body tumors. Additionally, it may be of use in screening for familial carotid body tumors and sequential follow-up of nonoperatively managed tumors.

Carotid Body Tumors

The surgical management of carotid body tumors requires identification and preservation of neural and vascular structures without compromising resection of the neoplasm. Fifteen patients were examined and treated for carotid body tumors at the Cleveland (Ohio) Clinic Foundation from 1979 through 1987. The benchmark of diagnosis is bilateral carotid angiography. When neural structures are free of tumor, meticulous dissection facilitates their preservation. Large tumor size increases risk for arterial resection necessitating reconstruction. The use of a vascular shunt minimizes the risk of cerebral ischemia. Postoperative intravenous digital subtraction angiography allows for evaluation of arterial repair. A retrospective review of 15 carotid body tumor resections performed in 14 patients revealed no evidence of tumor recurrence, no mortality associated with surgical intervention, no postoperative cerebrovascular accident, and limited morbidity associated with unavoidable sacrifice of neural elements.

Diagnosis and treatment of carotid body tumors.

The diagnosis and management of carotid body tumors are discussed, including the importance of good arteriography which allows visualization of all major feeding vessels. These include the carotid bulb, internal and external carotid arteries and the often neglected but important vertebral and ascending cervical arteries. Emphasis is placed on the importance of establishing tourniquet control of the common, internal and external carotid arteries. Surgeons removing carotid body tumors should be experienced in arterial wall repair by means of vascular shunts, end-to-end arterial anastomosis, and vein graft replacement of a segment of arterial wall.

Surgical management of carotid body tumors

Surgical management of carotid body tumors

Surgical management of carotid body tumor.

TUMOR of the carotid body, while not common and often benign and asymptomatic, continues to be a subject of great controversy. The confusion regarding indication for surgical intervention probably relates to inadequate knowledge regarding the natural history, incidence of malignancy and the risk of operative mortality and morbidity. The indication for surgical intervention has swung through all extremes in the past few decades. For a number of years complete removal was considered imperative, influenced by the report of Harrington et al 1 in 1941, which suggested that 50% of these tumors were histologically malignant. The authors, however, appreciated a more benign clinical course in spite of the morphologic appearance. LeCompte, 2 Lahey and Warren, 3 Reid, 4 and Martin 5 advised against removal of the carotid body tumor based on the incidence of high mortality and morbidity. Le-Compte stated that the carotid body tumor almost never gives rise to distant

ANGIOGRAPHY IN MANAGEMENT OF CAROTID BODY TUMORS.

THE PREOPERATIVE diagnosis of a carotid body tumor may tax the acumen and ingenuity of the most experienced and careful surgeon. Symptoms and signs are rarely specific, and often misleading. An extensive review of the literature indicates a correct preoperative diagnosis in only 10% of the reported cases. Recent reports 1,2 stress the potential malignancy of carotid body tumors. Fanning, Woods and Christian 2 list 25 malignant cases with proved metastases to the regional lymph nodes or to distant sites. This awareness of malignant changes along with advances in anesthesia and surgical technique, has directed fresh attention to the surgical management of these tumors. The indications for surgical removal of a carotid body tumor, and the selection of a specific surgical technique call for a thorough angiographic investigation. The value of carotid angiography was first mentioned by Engstrom and Hamberger 3 in 1957, for the diagnosis of a bilateral carotid