Management Of Carotid Body Tumors Research Articles

P.095 Role of selective neck dissections in the management of carotid body tumours

Background: Carotid body tumours (CBT) are rare neoplasms of the paraganglia at the carotid bifurcation. Histopathologic analysis alone is insufficient to confirm malignancy, requiring metastases to non-neuroendocrine tissue including cervical lymph nodes for definitive diagnosis. The role of selective neck dissection (SND) during CBT surgeries in detecting malignancy and guiding subsequent management remains uncertain. Methods: A retrospective case series was performed on all patients undergoing CBT surgeries with SND between 2002 and 2022. Data collection included demographics, genetic and laboratory testing, imaging, intra- and post-operative complications, follow-up and histopathology. Results: Twenty-one patients underwent CBT resection with SND. Of these, 3 had carotid artery injuries, and 5 had nerve injuries. One patient experienced peri-operative embolic strokes, presumed related to tumour embolization. Three patients were found to have lymph node involvement, confirming malignancy. Malignancy was significantly associated with the risk of carotid injury (p = 0.04.) Conclusions: SND is a useful adjunct in detecting malignancy during CBT resection. The incidence of malignancy in CBT is low but not negligible and SND should be considered in patients with suspected malignancy or high-risk factors. This study’s 14% incidence of malignancy suggests there may be a rationale for considering universal implementation of SND during CBT resection.

Surgical Management of Carotid Body Tumors: Experience of Two Centers

Carotid body tumors (CBT) are rare but require surgical resection given their potential for growth and malignancy. For some surgical teams, tumor hypervascularity justifies preoperative embolization to facilitate resection and limit complications. The objective of our study was to evaluate two different practices of surgical resection with or without preoperative embolization in a two-center cohort. A consecutive series of patients who underwent CBT surgery, from January 2011 to June 2019, were divided into 2 groups, as to whether they were (ECBT) or not (NECBT) preoperatively embolized. Both groups were compared specifically according to the duration of operation, postoperative complications, and length of stay. Twenty-two patients with a mean age of 48.5 ± 14.3 years were included. In the series, 23 CBT were resected: 13 were embolized preoperatively; the mean time between embolization and surgery was 2.62 days ± 1.50. Both groups were comparable based on characteristics of population and tumor, with a mean size of 33.2 ± 11.9 mm. We noted a significant increase in operation duration in the ECBT group: 151 min (±40.9) vs 87.0 min (± 21) p<0.01. There was no difference between the 2 groups regarding cranial nerve (50% vs 46%; p=1), sympathetic nervous system (20% vs 23%; p=1), or vascular nerve (20% vs 23%; p=0.18) complications. No cerebrovascular accident was identified. The length of stay was 3.60 days (± 1.78) vs 3.73 days (± 1.19; p=0.44). This study reflects the experience of two centers in the management of CBT which is a rare pathology with no standardized treatment. Our series showed no significant difference between the ECBT and NECBT groups regarding postoperative complications and length of hospital stay. The reduction in operating time in the NECBT group remains to be demonstrated.

1233 Role of Preoperative Embolization in the Surgical Management of Carotid Body Tumors: A Systematic Review and Meta-Analysis

Abstract Aim The role of preoperative embolization in the surgical management of carotid body tumors (CBT) remains a topic of debate. The aim of this study was to evaluate the effect of preoperative embolization on CBT resection. Method A systematic review and meta-analysis was conducted following the PRISMA protocol. Pubmed, Scopus and Web of Science were screened for studies published between 2010-2022. Primary outcomes investigated were intraoperative blood loss, operative time, length of hospital stay, and perioperative complications such as TIA/stroke, vascular injury and cranial nerve injury. Quality assessment of selected studies was performed using the Newcastle-Ottawa Scale (NOS). Publication bias was assessed using funnel plots and Egger’s regression test. Results Twenty-five studies were included in the systematic review, involving 1649 patients. Twenty-three studies were eligible for meta-analysis. The incidence of vascular injury necessitating intervention was significantly less in the preoperative embolization group (OR = 0.60; 95% CI: 0.42-0.84; P = .003). There was no statistically significant difference between the two groups with regards to intraoperative blood loss, operative time, length of hospital stay, incidence of TIA/stroke and cranial nerve injury. Subgroup analyses did not show significant difference between Shamblin I, II and III subgroups with regards to operative time. Conclusions This systematic review and meta-analysis found preoperative embolization to be significantly beneficial in reducing vascular injury. No statistically significant difference was found between the two groups regarding intraoperative blood loss, operative time, length of hospital stay and complications such as TIA/stroke and cranial nerve injury.

Multidisciplinary care improves outcomes for patients with carotid body paragangliomas-The UCLA experience.

To evaluate the effects and outcomes of multidisciplinary surgical approaches in the management of carotid body tumors (CBT). A single-center retrospective study at the University of California-Los Angeles Medical Center was conducted on patients who presented with CBTs and underwent surgical resections from 1998 to 2020. Statistical analysis was performed using IBM SPSS v27 and Excel. A total of 75 patients with 79 CBT resections were included. Operating surgical subspecialties included: 41.8% vascular surgery, 24.1% otolaryngology head and neck surgeons (OHNS), and 31.6% combined OHNS and vascular. 68.4% of tumors underwent preoperative embolization. EBL was directly correlated with tumor size. CBT size was similar for OHNS (30 mm) and vascular (31 mm) but was significantly larger for combined OHNS and vascular cases (38 mm). EBL was higher in combined cases (301 mL) compared to OHNS (124 mL) or vascular (203 mL) alone. Incidence of postoperative cranial nerve deficits was 7.8%, with combined OHNS and vascular cases having an incidence of 4.0% when compared to OHNS (5.3%) versus vascular surgery alone (12.1%). CBTs can be managed effectively by single surgical specialties with similar outcomes between vascular surgery and OHNS. In larger, higher grade tumors, however, a combined vascular and OHNS approach had lower incidence of postoperative cranial nerve injuries when compared to single specialty resections, despite a larger EBL. Thus, a multidisciplinary surgical approach suggests favorable outcomes with fewer incidence of cranial nerve deficits for larger, more complex CBT resections. 2b-Individual retrospective cohort study.

Surgical Management of Carotid Body Tumors: A Triple Center Retrospective Study in Sana’a City, Yemen

Surgical Management of Carotid Body Tumors: A Triple Center Retrospective Study in Sana’a City, Yemen

Multidisciplinary management of carotid body tumors: a single-institution case series of 22 patients.

Carotid body tumors (CBTs) are rare, slow-growing neoplasms derived from the parasympathetic paraganglia of the carotid bodies. Although inherently vascular lesions, the role of preoperative embolization prior to resection remains controversial. In this report, the authors describe an institutional series of patients with CBT successfully treated via resection following preoperative embolization and compare the results in this series to previously reported outcomes in the treatment of CBT. All CBTs resected between 2013 and 2019 at a single institution were retrospectively identified. All patients had undergone preoperative embolization performed by interventional neuroradiologists, and all had been operated on by a combined team of cerebrovascular neurosurgeons and otolaryngology-head and neck surgeons. The clinical, radiographic, endovascular, and perioperative data were collected. All procedural complications were recorded. Among 22 patients with CBT, 63.6% were female and the median age was 55.5 years at the time of surgery. The most common presenting symptoms included a palpable neck mass (59.1%) and voice changes (22.7%). The average tumor volume was 15.01 ± 14.41 cm3. Most of the CBTs were Shamblin group 2 (95.5%). Blood was predominantly supplied from branches of the ascending pharyngeal artery, with an average of 2 vascular pedicles (range 1-4). Fifty percent of the tumors were embolized with more than one material: polyvinyl alcohol, 95.5%; Onyx, 50.0%; and N-butyl cyanoacrylate glue, 9.1%. The average reduction in tumor blush following embolization was 83% (range 40%-95%). No embolization procedural complications occurred. All resections were performed within 30 hours of embolization. The average operative time was 173.9 minutes, average estimated blood loss was 151.8 ml, and median length of hospital stay was 4 days. The rate of permanent postoperative complications was 0%; 2 patients experienced transient hoarseness, and 1 patient had medical complications related to alcohol withdrawal. This series reveals that endovascular embolization of CBT is a safe and effective technique for tumor devascularization, making preoperative angiography and embolization an important consideration in the management of CBT. Moreover, the successful management of CBT at the authors' institution rests on a multidisciplinary approach whereby endovascular surgeons, neurosurgeons, and ear, nose, and throat-head and neck surgeons work together to optimally manage each patient with CBT.

SINGLE CENTRE EXPERIENCE WITH CAROTID BODY TUMOUR

Background: Carotid Body tumours (CBTs) are rare neuroendocrine tumours. Due to their proximity to vital structures including major vessels and cranial nerves, Surgical excision requires meticulous dissection and any injury to major vessels requires prompt repair. This study aimed to review our experience with the surgical management of Carotid Body Tumours. A Methods: retrospective study was performed on 20 patients who underwent excision of carotid body tumours at Vardhaman Mahavir Medical college and Safdarjung hospital, New Delhi between January 2003 to June 2022. Demographic data describing the presentation, preoperative and intraoperative details, and postoperative complications reported were tabulated and descriptive statistical analysis was done A total of 20 Results: patients were operated on. Complete resection was possible in all the patients. Vascular injury occurred in only 2 patients which were repaired promptly. Cranial nerve injury was reported in only 1 patient which resolved on follow-up. There was no incidence of stroke or recurrence. Conclusions: Periadventitial Excision is the treatment of choice for carotid body tumours and is a safe and effective procedure with minimal intraoperative and postoperative complications.

Diagnosis and Management of Carotid Body Tumors

Diagnosis and Management of Carotid Body Tumors

Safety of Nonoperative Management of Carotid Body Tumors

Carotid body tumors (CBTs) are rare neuroendocrine paragangliomas that are typically asymptomatic and benign with a low rate of biochemical functionality. Historically, early surgical excision was recommended to prevent development of CBT-related complications. Yet, CBT resection can result in significant injury to cranial nerves and the carotid artery. Recent work has shown successful primary observation without resection of noncarotid body, cranial paragangliomas (glomus jugulare, tempanyomastoid, vagal body) with slow growth and a low rate of neuropathies.

Multispecialty surgical management of carotid body tumors in the modern era

ObjectiveThe objective of this study was to assess the perioperative and long-term outcomes of carotid body tumor (CBT) resection with a multispecialty (head and neck surgery/vascular surgery) approach. MethodsOur institutional data registry was queried for Current Procedural Terminology codes (60600, 60605) pertaining to CBT excision. These patient records and operative reports were individually reviewed to determine laterality, preoperative tumor embolization, operative time, estimated blood loss, need for intraoperative transfusion, intraoperative electroencephalogram changes, intraoperative division of the external carotid artery, carotid artery repair, resection of the carotid bifurcation, tumor volume, final pathology, cranial nerve injury, stroke, death, and clinical or radiographic evidence of recurrence. ResultsFrom 1996 to 2018, 74 CBT resections were identified in 68 patients (41 [60%] females; mean age, 50.83 years). The mean tumor volume was 9.92 ± 14.26 cm3 (range, 0.0250-71.0627 cm3). Embolization was performed by a neurointerventional specialist in 27 CBT resections (36%) based on size (embolization 14.27 ± 16.84 cm3 vs 7.17 ± 11.86 cm3; P = .063) and superior extension. This practice resulted in one asymptomatic vertebral dissection, which postponed the surgery. There was a trend toward greater blood loss in the embolization group (embolization 437 ± 545 mL vs 262 ± 222 mL; P = .17); however, no transfusions were required in any patient. The mean operative time was also significantly longer in the embolization group (198.33 ± 61.13 minutes vs 161.5 ± 55.56 minutes; P = .03). Three resections had reversible intraoperative electroencephalogram changes, one of which occurred during carotid clamping. These changes resolved with shunting. Eight external carotid resections (11%) and 6 carotid reconstructions (8.1%; two primary, two patch, and two primary anastomosis) were required. Malignancy was identified in four tumors (5.4%), accounting for four of the six carotid reconstructions. There were no postoperative cranial nerve injuries, no strokes, no reexplorations, and no deaths. One patient developed transient dysphagia from pharyngeal tumor infiltration. Long-term follow-up (mean, 43 ± 54 months), available in 61 of the 68 patients (89.7%), revealed three (4.4%) recurrences. ConclusionsThis large, single-institution series demonstrates that a multispecialty team combining two surgical skill sets for the treatment of this rare, challenging condition yields unparalleled low complication rates with short operative times. This approach, including long-term surveillance for recurrent disease, should be considered to optimize outcomes of CBT resection.

Contemporary management of carotid body tumors in a Midwestern academic center

BackgroundCarotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection. MethodsA single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX). ResultsAmong 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21–79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm3 vs 205 cm3, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1–9 days). At a mean follow-up of 12 months (range 1–63 months), there has been no recurrence. ConclusionAlthough carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.

Surgical Management of Carotid Body Tumor and Risk Factors of Postoperative Cranial Nerve Injury.

To identify risk factors of postoperative cranial nerve injury (CNI) following surgical treatment of a carotid body tumor (CBT) by retrospective analysis of the data during the past decade in our center. From May 2008 to September 2018, patients who underwent CBT resections at the Department of Vascular Surgery, Zhongshan Hospital, Fudan University, were included in the study. Demographic, preoperative, intraoperative, and postoperative data of patients were collected and analyzed. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors of CNI. A total of 203 CBTs were excised in 196 patients; 17.7% was classified as Shamblin I, 59.1% as Shamblin II, and 23.2% as Shamblin III. CNI after surgery occurred in 57 (28.1%) patients. Postoperative CNI, external carotid artery (ECA) ligation, internal carotid artery (ICA) reconstruction, tumor volume, and established blood loss (EBL) were significantly correlated with Shamblin classification. On univariate analysis, there were statistically significant differences in Shamblin classification (p = 0.002), tumor volume (p = 0.014), number of lymph nodes removed (NOLNR) (p < 0.001), and EBL (p = 0.019) between two groups (with and without CNI after surgery). Multivariate logistic regression analysis revealed a significant positive correlation between CNI and Shamblin III (AOR, 4.744; 95% CI, 1.21-18.56; p = 0.025) and NOLNR (AOR, 0.25; 95% CI, 1.23-1.46 for each three-interval increase, p < 0.001). Shamblin III and NOLNR are independent risk factors of CNI for patients who undergo CBT resections.

Carotid body tumor surgery: challenges and management

Purpose To assess the challenges and management of carotid body tumors (CBTs). Adequate planning by the surgeon can greatly reduce adverse events of such rare and difficult tumors. Background CBTs are rare. Despite over a century of describing surgery, controversy remains surrounding details of their treatment. Most complications are considered technically preventable. Patients and methods This prospective study included 13 cases diagnosed as CBT. Patients were subjected to clinical evaluation, carotid duplex ultrasound, computed tomography angiography scan, and sometimes MR angiography. All patients underwent CBT resection and when needed vascular reconstruction. Patients were classified into three groups depending on Shamblin classification. Results Mean operative time was longer in patients of Shamblin class 3 (5.4±0.77 h; range, 4.5–6 h; P Conclusion Early surgical excision by a vascular surgeon is the only proven cure for CBTs, because they are small and easy to remove. However, if neglected, there will be many challenges, as most tumors can become locally invasive. Meticulous periadventitial (and sometimes subadventitial) dissection can greatly reduce the rates of complications.

Management of carotid body tumor: thirteen years of experience

Management of carotid body tumor: thirteen years of experience

Carotid body tumor: what treating surgeon wants to know in radiological evaluation? – A case report

Background: Carotid body tumors (CBTs) are benign, but they are quite controversial for the management because of their location and symptoms. Cervical CBTs are slightly uncommon paragangliomas. These are highly vascular tumors. Their location is at the bifurcation of common carotid artery (CCA) which is adjacent to many cranial nerves. Surgical management involves a lot of morbidity and mortality. Case Report: A 48-year-old female reported with painless small swelling on the right side of the neck region just below the angle of the mandible. The radiological evaluation by ultrasonography, contrast-enhanced computerized tomography, and magnetic resonance angiography revealed the swelling as carotid body tumor. The patient had been advised surgical management as presently the entity was almost without any symptoms. Conclusion: The cross-sectional imaging plays a great role in the diagnosis and management of CBTs as they are associated with many complications. The treating surgeon had to be very careful about surgical extirpation.

Diagnosis and treatment of carotid body tumors: A retrospective analysis of a single-center experience over 12 years

Introduction: Carotid body tumor (CBT) is a neuroendocrine tumor, located at the carotid artery bifurcation. Management of such tumors is challenging due to the silent presentation and difficulties encountered during surgical excision which is the standard treatment method. Aim: This study aimed to report our experience in the diagnosis and management of CBTs. Materials and Methods: A retrospective analysis of all CBTs treated at our center during the period from January 2005 to March 2017. The analysis was based on data collected from histopathology database, hospital records, and the follow-up notes from the clinic. Results: A total of 32 CBTs were excised in 28 patients. There were 22 females and 6 males, with a mean age of 44 years. Twenty-four patients had unilateral tumors and bilateral tumors were present in four patients (15%). The mean size of the tumors was 3.5 cm. Surgical excision was achieved under general anesthesia in all cases. Intraoperatively, vascular repair in any form was needed in 41% and permanent cranial nerve injury was detected in 16% of cases. Histopathologically, incomplete excision was found in 13% of cases, and no metastasis was detected. During the follow-up period, there was only one case of recurrence. Conclusions: CBTs are challenging pathology. Despite the lack of recommendations for treatment, early resection is performed to avoid the complications associated with the increased size and the malignant transformation. Routine follow-up for all patients is advised due to the potential recurrence of these tumors.

CAR 15. Surgical Management of Carotid Body Tumors: 24 Years’ Experience at Royal Medical Services, Amman, Jordan

CAR 15. Surgical Management of Carotid Body Tumors: 24 Years’ Experience at Royal Medical Services, Amman, Jordan

Current application of endovascular interventions in surgical management of carotid body tumor

Carotid body tumors (CBTs) are rare neoplasms at the carotid bifurcation. Surgical excision is currently the only curable treatment for CBTs but is associated with high incidence of morbidities and mortality, due to the hyper-vascularity and proximity to carotid vessels and cranial nerves of the tumors. In the last decades, endovascular interventions, including preoperative trans-arterial embolization and carotid stents, have been utilized in surgical excision of CBTs with the attempt to reduce perioperative complications and improve surgical outcomes. However, controversial results have been reported with regard to the efficacy of such techniques. This review summarized the current application of endovascular interventions in surgical treatment of CBTs, with emphasis on their impacts on surgical conducting and perioperative complications.

The Outcome of Multidisciplinary Management of Carotid Body Tumors: Retrospective Cohort Study.

Carotid body tumor (CBT) is a rare paraganglionic hyper-vascular tumor of the carotid body. The standard treatment for CBTs is surgery, but it involves risk. The study is aimed to assess the CBTs and evaluate the outcome of multidisciplinary management. A retrospective cohort study included patients with CBTs who were managed by surgical excision between May 2006 and April 2018. A multidisciplinary team was established to excise the tumor completely with minimal neurovascular compromise. The study comprised of 32 patients in the age group of 23-65years. The main presentation was a unilateral painless neck mass. Six cases (18.75%) were Shamblin I, 10 (31.25%) Shamblin II and 16 (50%) Shamblin III. Complete excision was performed for all cases. Ligation of the external carotid artery was done in 15 cases (46.88%) and repair of the internal carotid artery in 6 (18.75%). Postoperative cranial nerve complications occurred in six patients (18.75%): four transient hypoglossal pareses and two hoarseness of voice. Histopathologically, one case (3.125%) was malignant. No recurrence was detected through the follow-up period. A multidisciplinary approach is essential for management of CBTs. Early diagnosis and surgical resection minimize morbidity and carry good surgical outcome. ChiCTR1800018722 (Agency: Chinese Clinical Trial Registry).

NESVS6. Multispecialty Surgical Management of Carotid Body Tumors in the Modern Era

The objective of this study was to assess the perioperative and long-term outcomes of carotid body tumor (CBT) resection with a multispecialty (head and neck surgery/vascular surgery) approach. Our institutional data registry was queried for Current Procedural Terminology codes (60600, 60605) pertaining to CBT excision. These patient records and operative reports were individually reviewed to determine laterality, preoperative tumor embolization, operative time, estimated blood loss, need for intraoperative transfusion, intraoperative electroencephalography changes, intraoperative division of the external carotid artery, carotid artery repair, resection of the carotid bifurcation, tumor volume, final pathology, cranial nerve injury, stroke, death, and clinical or radiographic evidence of recurrence. From 1996 to 2018, there were 74 CBT resections identified in 68 patients (41 [60%] female; mean age, 50.83 years). Mean tumor volume was 84.93 ± 116.15 cm3 (range, 0.2-568 cm3). Embolization was performed by a neurointerventional specialist in 27 (36%) CBT resections based on size (embolization 134 ± 136 cm3 vs 51 ± 84 cm3; P = .005) and superior extension. This resulted in one asymptomatic vertebral dissection that postponed surgery. Blood loss remained significantly higher in the embolization group (470 ± 542 mL vs 227 ± 204 mL; P = .04); however, no transfusions were required in any patient. Mean operative time was also significantly longer in the embolization group (198.88 ± 56.38 minutes vs 153.53 ± 52.45 minutes; P = .00). Three resections had reversible intraoperative electroencephalography changes, one of which occurred during carotid clamping. These changes resolved with shunting. Eight (11%) external carotid resections and six (8.1%) carotid reconstructions (two primary, two patch, two primary anastomosis) were required. Malignant disease was identified in four (5.4%) tumors, accounting for four of six carotid reconstructions. There were no postoperative cranial nerve injuries, no strokes, no re-explorations, and no deaths. One patient developed transient dysphagia from pharyngeal tumor infiltration. Long-term follow-up (mean, 43 ± 54 months), available in 61 of 68 (89.7%) patients, revealed 3 (4.4%) recurrences. This large, single-institution series demonstrates that a multispecialty team combining two surgical skill sets for the treatment of this rare, challenging condition yields unparalleled low complication rates with short operative times. This approach, including long-term surveillance for recurrent disease, should be considered to optimize outcomes of CBT resection.