Treatment Of Carotid Body Tumors Research Articles

Retrocarotid dissection technique compared to the caudocranial approach for the surgical treatment of carotid body tumors: A 15-year experience.

Carotid body tumors are rare neoplasms with malignant potential. We aim to follow up on our initial experience published in 2015 and compare the occurrence of complications and postoperative outcomes with the use of retrocarotid dissection (RCD) against the standard caudocranial (SCCD) technique. This was an observational, case-control study in which we analyzed all of the carotid body tumor resections performed from 1986 to 2022. Parametric and nonparametric tests were used accordingly. Statistical analysis was performed on Stata 17. A total of 181 surgical procedures were included, mean age was 56 years (± 13.63), and 168 (93%) were performed in women. The mean medio-lateral diameter was larger in the RCD group (2.85 ± 1.57 cm vs 1.93 ±1.85 cm; p = 0.002) and presurgical embolization was more frequently performed in the SCCD group (27.5% vs 0.7%; p < 0.001). A total of 40 (22.09%) resections were performed using the SCCD technique. In contrast, in 141 (77.91%) procedures the RCD technique was used. The mean surgical time in the RCD group was lower (197.37 ± 70.56 min vs 232 ± 98.34 min; p = 0.01). No statistically significant difference was found between SCCD and RCD in terms of vascular lesions (n = 20 [11.04%], 15% vs 9%, respectively; p = 0.36), transient or permanent nerve injuries (25% vs 33%, respectively; p = 0.31), or mean intraoperative bleeding (SCCD: 689.95 ± 680.05 mL vs RCD: 619.64 ± 837.94 mL; p > 0.05). RCD appears to be a safe and equivalent alternative to the standard caudocranial approach in terms of intraoperative bleeding or vascular lesions, with a sustained, significant decrease in surgical time.

Fifteen Years of Experience with Surgical Management of Bilateral Non-familial Carotid Body Tumors

Bilateral carotid body tumors (CBTs) clinical manifestation is infrequent. We conducted this work to describe our experience in the surgical treatment of bilateral CBT and to analyze our results. A retrospective, observational study. We analyzed the totality of bilateral CBT resections that had been performed in our institution from January 2008 to September 2023. Data was obtained from medical records and anonymized, ethics approval was obtained from our institution committee. As the number of observations was less than those required by the central limit theorem our sample was considered nonparametric. Statistical analysis was performed on Stata17. We evaluated 16 patients with a total of 32 CBT; surgical resection was performed in 28 cases (87.50%). Median age of the patients was 60years (interquartile range [IQR] 46-64). Regarding the Shamblin classification, 9 CBTs (32.14%) were classified as Shamblin I, 11 (39.29%) as Shamblin II, and 8 (28.57%) as Shamblin III. The median Distance to the Base of the Skull (DTBOS) was 3.5cm (IQR 2.7-5.1), and the median tumor volume was 11.25cc (IQR 3.4-18.7). The median bleeding volume was 300ml (IQR 200-500), and the median surgical time was 190min (IQR 145-240). All surgeries were performed using the Retrocarotid Dissection technique. We documented 9 (32.14%) cases of nerve injuries, all of which were transitory. In the median regression a statistically significant association was found between DTBOS, Shamblin classification and tumor volume with intraoperative bleeding and length of stay. Surgical treatment remains safe and should be considered the gold standard for accurate histologic diagnosis. DTBOS and tumor volume, in addition to Shamblin classification, must be considered in preoperative planning to predict bleeding and hospital stay.

The Surgical Treatment of Carotid Body Tumor as Well as the Prevention and Management of Complications.

The carotid body tumor (CBT) is a rare paraganglioma neoplasm that often occurs in the head and neck anatomical region. Carotid angiography continues to be widely regarded as the preferred diagnostic method for this particular malignancy. Surgical intervention has been widely acknowledged as the primary approach for managing CBTs. However, the resection of CBTs poses significant technical challenges due to its specific anatomical position. To mitigate the incidence of intraoperative and postoperative challenges, we have conducted a comprehensive review of both domestic and international literature to consolidate the surgical approach and strategies for preventing and managing complications associated with this particular tumor.

Quality of Life and Postoperative Outcomes After Surgery in Carotid Body Tumor Patients

The aim of this study was to study the quality of life (QoL) and postoperative outcomes in patients with carotid body tumor (CBT) undergoing surgery. This was an observational study in a tertiary care center in North India. A total of 18 patients with CBT undergoing surgery were included. All patients were operated upon by a vascular surgeon at the center. The patient demographics, disease characteristics, intraoperative data, and postoperative outcomes were recorded. All patients were followed for a period of ≥3 months following surgery. The QoL was assessed using the European Organization for Research and the Treatment of Cancer (EORTC) questionnaires. The EORTC QLQ-30 was used to assess global health and functional health status, whereas the EORTC H&N-35 was used to assess symptomatic health. The QoL data were recorded preoperatively for all patients, whereas 11 patients agreed to provide postoperative QoL data using physical and telephonic follow-ups. The preoperative and postoperative QoL data were compared. Among 18 patients, 11 (61%) were female and 7 (39%) were male. The median age of patients was 35 years (range, 21-62 years). The median duration of symptoms at presentation was 3.5 years (range, 0.17-13 years). The Shamblin grade was I in one (5%), II in 12 (67%), and III in five (28%) patients. The disease was bilateral in two (11%) patients. A family history of CBT was present in one (5%) patient. The size of the tumor ranged from 3 to 10 cm. Of all the patients, two patients (11%) underwent preoperative angioembolization. All patients underwent CBT excision. The mean operative time was 2.7 ± 1.0 hours. The mean blood loss was 230 ± 232 mL. Vascular reconstruction was required in three patients (17%). Nerve resection was required in two patients (11%). Both patients had tumor sizes of >7 cm. Iatrogenic nerve injury occurred in one patient (5%). Postoperatively, one patient (5%) developed neck hematoma, which required re-exploration. The median hospital stay was 3 days (range, 1-17 days). The median follow-up was 34.5 months (range, 3-56 months). The neurological deficits were present in five patients (28%) at discharge and three patients (17%) at ≥3 months follow-up (Table I). No recurrences were observed. The change in QoL was non-significant (P > .05) in global health, functional health, and symptomatic health at ≥3 months follow-up. Surgery is an effective modality for the treatment of CBT; however, it does not affect the QoL significantly.TableNeurological deficits in patients with carotid body tumor (CBT) after surgeryDeficitAt dischargeAt ≥3 months follow-upHoarseness of voice5 (28)3 (17)Horner syndrome2 (11)0 (0)Dysphagia1 (5)1 (5)Tongue deviation2 (11)1 (5)Facial deviation1 (5)0 (0)Data are presented as number (%). Open table in a new tab

Retrospective, multicenter study of surgical treatment for carotid body tumors with or without preoperative embolization.

Carotid body tumor (CBT) is the most common head and neck paraganglioma. Whether preoperative embolization benefits CBT patients who will receive surgical resection is still controversial. In this multi-center retrospective study, we collected data from patients with CBT who received surgical treatment without (group A) or with preoperative embolization (group B) from 2011 to 2019. The primary outcome was the rate of death or stroke after 3 years of follow-up. The secondary outcomes of the study were length of operation (LOO), intraoperative blood loss (IBL), length of stay (LOS), rate of recurrence, and rate of cranial nerve (CN) injuries. Descriptive statistics were used to analyze the demographics, clinical characteristics, complications, and follow-up results of the patients. Between January 2011 and October 2019, 261 consecutive patients (107 male and 154 female) entered analysis. After 3 years of follow-up, no patient died in both groups. Only three patients with stroke were detected: 2/226 (0.9%) in group A vs. 1/35 (2.9%) in group B (p = .308). The LOO in group A was 132.6 ± 64.6min compared with 152.9 ± 40.4min in group B (p = .072). IBL in group A was 375.4 ± 497.8ml compared with 448.0 ± 270.8ml in group B (p = .400). LOS in group A was 8.3 ± 2.0 days compared with 7.4 ± 1.7 days in group B (p = .016). Seventy-two CN injuries were detected: 65/226 (28.8%) in group A vs. 7/35 (20.0%) in group B (p = .281). There were 65 temporary CN injuries (59 in group A vs. 6 in group B) (p = .254) and seven permanent CN injuries (6 in group A vs. 1 in group B) (p = .945). Three most frequently injured cranial nerves were the pharyngeal branch and superior laryngeal nerve (12.3%), recurrent laryngeal nerve (7.7%) and vagus nerve (7.3%). There was insufficient evidence to support the efficacy of preoperative embolization. CBT resection alone had a similar rate of stoke, recurrence, and CN injuries when compared with CBT resection with preoperative arterial embolization. Meanwhile, CBT resection alone did not increase LOO and IBL.

Carotid body tumors: A retrospective case series of 11 patients.

Carotid body tumors (CBTs) are uncommon neuroendocrine tumors located near the carotid bifurcation within the carotid body. CBTs are slow-growing; affected individuals may remain asymptomatic for years and are often diagnosed incidentally following imaging studies. When present, symptoms are nonspecific. Because incidence is low, retrospective review of CBT case series is an ideal study design for investigating common symptomology, identifying successful diagnostic tools, and evaluating treatment outcomes. This article describes a case series of 11 patients treated for CBTs at an academic medical center in the Southeastern US. A retrospective chart review of 11 patients who had been discharged from the hospital following treatment for CBTs between 2017 and 2021 was conducted. Descriptive statistics were used to delineate the case series. There were four males (36%) and seven females (64%) included in the retrospective case series. The age range was 34 to 79 with a mean of 56.73 (standard deviation 16.038). Three patients were found to have a neck mass on physical exam. Additional symptoms included vocal cord paralysis, facial paralysis, ischemic stroke, Bell palsy, dysphonia, and dizziness. Two patients had familial CBTs. Ten patients underwent surgical excision. This case series showed that patients with CBTs should be assessed with a combination of history and physical exams along with imaging studies to confirm the diagnosis. Because CBTs may become malignant and metastasize, it is important for NPs to be knowledgeable about presenting symptoms and appropriate diagnostic studies to be able to refer patients to vascular surgeons early to prevent complications.

Carotid Body Tumor Presentation, Management, and Outcome an Institutional Experience – 12-Year Experience

Objective: This study aimed to analyze the presentation and treatment modalities of carotid body tumor (CBT) and evaluate the outcomes and complications of surgical treatment of CBT. Methodology: Twenty-seven CBT patients treated surgically from January 2012 to August 2022 were included in the study. Patient presentation, diagnostic modalities, surgical and radiological interventions, outcomes, and complications were analyzed. Results: (1) A total of 27 patients were studied, with an age ranging from 13 to 65 years (median age - 45 years), in which male preponderance was found (male: female = 2.5:1), (2) Local swelling was the most common symptom (n = 27), with other symptoms being hoarseness of voice, dysphagia, and ear/neck pain, (3) Left laterality was found in 76.2% of patients, whereas 17.3% of them were right sided with 6.5% of bilateral cases, (4) 15 patients (55.5%) out of the 27 total patients, were classified in Shamblin’s type II, 8 patients (29.6%) in Shamblin’s type I, and the remaining 4 patients (14.8%) as Shamblin’s type III CBTs, (5) Thirteen (48.1%) patients underwent preoperative angioembolization. All (100%) patients underwent complete excision (6) Operative site hematoma was the most common postoperative complication encountered. All patients are asymptomatic with the minimum of 6-month follow-up. Conclusion: Careful preoperative evaluation, which included appropriate modality for diagnosis, preoperative angioembolization for large tumors, meticulous dissection, and good postoperative care, resulted in complete excision of all the tumors and with less complications postoperatively. Shamblin III had a high risk of postoperative neurovascular complications. Therefore, early detection and prompt surgical resection of CBTs will decrease surgical morbidity.

Microsurgical treatment of carotid body tumors using periadventitial dissection: Analysis of outcomes and prognostic factors in a neurological referral center.

Surgical resection for carotid body tumors (CBTs) is the gold standard of treatment and continues to be a challenging procedure, commonly associated with high vascular injury rates and neurological complications. It is a retrospective case series study between January 2002 and November 2020, with a mean follow-up of 29 months in a single nationwide referral center. Thirty-one patients diagnosed with a carotid body tumor and treated with microsurgical periadventitial resection were included in the study. Patients' demographics, comorbidities, clinical, radiological factors, and tumor grade, evaluated by the Shamblin scale, were obtained. Statistical analysis was performed on all collected data. In this study, we included 31 patients (32 tumors), 80% of the patients were female, and 20% were male, with a mean age of 53 years. One patient presented with bilateral lesions, while 17 tumors were located on the left side. The most frequent symptom was a painless, slow-growing neck mass in 74% of patients. Using the Shamblin classification, 13% of tumors were Grade I, 53% Grade II, and 34% Grade III. In the postoperative period, 3% of patients presented with permanent cranial nerve deficit, while none had vascular injuries or postoperative stroke. A tumor >5 cm increased the risk for nerve lesion by 11 times (OR 12.6, CI 95% 7.4-11.4, P < 0.001). Preoperative embolization followed by periadventitial resection by means of a microsurgical technique is a safe and effective approach to remove CBT, with 3% cranial nerve injury rate and no need for vascular sacrifice or reconstruction.

Carotid body tumor encounters over a two-decade period in an academic hospital.

Carotid body tumors (CBTs) are rare and mostly benign. Research outcomes usually arise from single-center data. We conducted this study to present the characteristics and outcomes of patients who underwent surgical resection of CBT at our hospital over the past 20 years. In this retrospective review, the records of CBTs in our hospital were reviewed between 1998 and 2021. All patients who underwent CBT resection were included. The follow-up period was 12 months. A total of 44 CBTs were treated in our hospital. The male-to-female ratio was 1:2.4. Only 4.5% of patients had Shamblin I tumors. Patients with Shamblin II and III tumors were 56.8% and 38.6%, respectively. Duplex scan was used to diagnose CBT in all of the patients. The majority of our patients (97.7%) did not receive any preoperative embolization despite an average tumor size of 4.9 cm. Cranial nerve injuries were observed in 29.5% of cases. Meanwhile, stroke was reported in only two cases (4.5%). No deaths were encountered. Surgery is the definitive treatment for CBT. Size and local extension appear to be the main reasons for adverse events rather than surgical techniques. Our results are consistent with those of previously published studies. Good outcomes are expected in high-volume centers with appropriate preoperative imaging.

Outcomes in the treatment of carotid body tumor, 20 years of experience

Outcomes in the treatment of carotid body tumor, 20 years of experience

The Comparative Outcomes of Particulate Versus Coil Preoperative Embolization for Carotid Body Tumors.

Till now, the effect of different embolic materials (particulate vs coil) on pre-embolization of carotid body tumors remains poorly understood. The aim of this study was to explore the comparative results between particulate and coil embolization for carotid body tumors. Thirty-seven patients with carotid body tumors who underwent embolization before surgical resection were reviewed and analyzed in this retrospective study between 2008 and 2020. Twenty-one patients were included in the particulate group, while 16 patients were included in the coil group. All procedure-related details, complications and 5-year follow-up data were collected in the study. The preoperative embolization time was obviously longer in the particulate group than in the coil group (42.6 ± 12.3 min vs. 33.7 ± 10.1 min, P =.02), and the fluo time of the procedure (864.5 ± 240.9 s vs. 729.6 ± 251.5 s) and cumulative air kerma (634.6 ± 188.4 mGy vs. 486.7 ± 164.7 mGy) value were higher in the particulate group (P =.01). The incidences of total adverse events in both groups were not significantly different (28.6% vs. 25.0%, P >.05); however, two cases of ectopic embolization only occurred in the particulate group. Interestingly, medical expenditure was higher in the particulate group than in the coil group (P =.02). For the 3-year follow-up evaluation, recurrence and all-cause mortality were similar in both groups (P >.05). Preoperative embolization with coils could be relatively safe, have a lower radiation dosage and be cost-effective for the treatment of carotid body tumors.

Meta-Analysis of the Effects of Preoperative Embolization on the Outcomes of Carotid Body Tumor Surgery

ABSTRACT Background Carotid body tumors (CBTs) are situated at the bifurcation of the common carotid artery within the adventitia, and are reported to be the most common head and neck paragangliomas. Surgery is the gold standard for curative treatment of resectable CBTs and is recommended in otherwise healthy patients because of the risk of local complications related to tumor size and a small but definite risk of malignancy. Preoperative embolization has been shown to reduce potential intraoperative blood loss and provide the surgeon with greater ease and safety in excising the tumor, thus reducing the operation time and morbidity. However, other physicians have stated that although blood loss may be reduced after preoperative embolization, transfusion requirements are not affected, and that the embolization procedure adds a significant risk for stroke. Therefore, the purpose of the current study was to compare the surgical outcomes of patients undergoing CBT surgical resection with and without preoperative embolization. Aim To evaluate the need for preoperative embolization for the treatment of carotid body tumor. Methodology A meta-analysis study is done to compare the surgical outcomes of patients undergoing CBT surgical resection with and without preoperative embolization. Results Our meta-analysis for evaluation of the effects of preoperative embolization on the outcomes of carotid body tumor surgery, included (14) studies with a total number of patients (n = 477).The results of these studies showed no statistically significant difference between preoperative embolization group and non embolization group in carotid body surgery for (blood loss &amp; operation time). Preoperative embolization did not reduce risk of postoperative complications. Conclusion Preoperative embolization shows no statistically significant reducing in blood loss and operation time, also embolization does not decrease incidence of postoperative complications. It seems that embolization should not be a routine part of carotid body tumor surgery especially with the known potential risks and complications of this procedure .

Improving Outcomes in Carotid Body Tumors Treatment: The Impact of a Multidisciplinary Team Approach

The purpose of this study was to evaluate how a multidisciplinary approach, including patients and familiar genetic counseling, preoperative succinate-dehydrogenase (SDH) gene mutation analysis, preoperative adjunctive endovascular procedures (PAEPs) and postoperative rehabilitative team may affect the outcomes in patients who underwent surgery for carotid body tumors (CBTs). Fifty-seven consecutive CBT resections were performed from January 1995 to December 2019 in a single center institution. Two groups of patients were compared: group A (1995-2003; n = 10) and group B (2004-2019; n = 47), treated before and after the establishment of a multidisciplinary approach to CBTs. Group A and group B were evaluated retrospectively and prospectively for SDH mutations, respectively. PAEPs (external carotid artery stenting, percutaneous transfemoral embolization or direct percutaneous puncture of the tumor with simultaneous embolization) were performed only in patients of group B, when the size of the tumor exceeded the 45 mm. Primary endpoints were blood loss (BL) and cranial nerve injuries. Secondary endpoint was the number of new silent masses (NSMs) discovered after genetic evaluation. SDH mutations were found in 2 patients of group A and in 11 patients of group B. There were no significant differences in mass diameter between the groups. A significant difference regarding the surgical procedure time was observed in the 2 groups, with a higher time in the group A (Group A: 180 ± 77.3; Group B: 138 ± 54.5, P= 0.04). BL was significantly lower in group B (203 ± 69.5 mL vs. 356 ± 102 mL; P = 0.0001), as well as for patients underwent PAEPs vs. those underwent direct surgery (n = 15, 149 ± 53 mL vs. n = 42, 273 ± 88 mL; P = 0.0001). No differences between transient and persistent cranial nerve injuries were observed between the 2 groups. Carotid reconstruction was necessary for 2 patients of group A (n = 2 vs. n = 0; P = 0.02). Unilateral tumor recurrence was detected in 7 patients, with a significantly higher rate (P ≤ 0.002) in patients carrying SDH mutations compared to those without SDH mutation (wild-type). SDH mutations detected in the groups lead to discover 7 NSMs (group A n = 1 vs. group B n = 6; P = 1.00). The impact of the multidisciplinary team suggests that surgical resection still remains the gold standard for the treatment of CBTs, but the use of PAEPs in selected cases may reduce surgical procedure time, BL and the need for reconstructive carotid surgery. Genetic counseling and SDH gene analysis allow to diagnose NSMs in asymptomatic patients. Larger studies should be considered to evaluate the effectiveness of postoperative rehabilitative program.

Comparison of 3 techniques of surgical treatment of carotid body tumors

Carotid body tumors (CBTs) are benign but challenging. This study compared outcomes of 3 techniques of the surgical treatment of CBTs. This retrospective observational study was conducted from April 2013 to March 2019. The 38 patients enrolled in the study had primary tumors, including 1 with bilateral tumors and another with adrenal gland pheochromocytoma. We collected data on age, sex, size of tumor, Shamblin classification, treatment, blood loss, operative time, hospital stay, complications, and recurrence. Statistical analyses were performed using IBM SPSS Statistics version 20 software. Twenty-four patients were male, and 12 were female, and they ranged in age from 11 to 71 years. Cases were assigned to Shamblin groups I (n=6), II (n=19), and III (n=14). Tumor size ranged from 2.0×2.0 cm to 5.0×6.0 cm. Eleven CBTs underwent blunt dissection (BD), 20 underwent BD plus resection of external carotid artery division plus vessels of encapsulation with allograft dermal matrix (BD+RECA+VE), and 8 tumors underwent surgical resection of tumors plus common carotid artery-internal carotid artery artificial vascular reconstruction (SR +C-IAVR). No perioperative death or stroke occurred. There was a significant difference between Shamblin groups I, II, and III in terms of the size of the tumor, type of treatment used, blood loss, operative time, hospital stay, and complications. Six patients had mandibular branch facial nerve transient paresis; 7 patients had hypoglossal nerve dysfunction; 3 patients had Horner syndrome; and dysphasia occurred in 2 patients. The patients were seen in follow-up for 16 to 45 months, and 1 recurrence was observed. Three surgical techniques-BD, BD+RECA+VE, and SR+C-IAVR-are safe and feasible for the treatment of CBTs according to Shamblin classifications.

Carotid body tumors: what have we learned in 5 years?

Objectives: The present study aimed to retrospectively evaluate patients who were operated for carotid body tumors (CBT) in our clinic. Methods: The present study involved 19 patients who underwent surgical CBT removal in the Otorhinolaryngology- Head and Neck Surgery Department of Karadeniz Technical University Medical Faculty between 2013 and 2018. Sociodemographic characteristics, clinical presentation and findings of physical examination, Shamblin classifications based on preoperative radiological images, surgical procedure, histopathological diagnosis and complications were recorded from hospital records. Results: Seven of the patients were male and 12 were female. The mean age of the patients was 48.8 years and the most frequent symptom was a painless mass in the neck. According to the Shamblin classification, seven of our patients had Shamblin type I, nine patients had Shamblin type II and three patients had Shamblin type III tumors. Twelve patients had preoperative embolization of the tumor and seven patients were operated without embolization. Three patients had intraoperative carotid artery injury-related complications, whereas one patient had weakness in tongue movements due to hypoglossal nerve paresis. Conclusion: The main treatment for CBT is surgery, however, preoperative embolization is still controversial. Successful management of patients with CBT can be achieved via a multidisciplinary approach with the participation of head and neck surgery, cardiovascular surgery and radiology departments.

Head and neck paragangliomas: 30-year experience.

We aimed to review our experience and the changing trends in the management of head and neck paragangliomas (HNPG) over the last three decades. We retrospectively reviewed 103 patients with HNPG treated at our center (1986-2017). We included patients treated with surgery, radiotherapy, and patients maintained under active surveillance. Of the surgically treated patients (n = 79), 20% (12/59) of the carotid body tumors (CBT) had a cranial nerve deficit as sequela compared to 95% (19/20) of the non-CBT. Radiotherapy controlled growth in all tumors treated with this modality (n = 10). Of the initially observed patients, 70% (14/20) remained stable and did not require additional treatment. Stratifying by decades, there was a progressive increase in patients initially attempted to be observed and a decrease in upfront surgery. No deaths attributable to the HNPG were encountered. Surgery is an effective treatment for CBT. Nonsurgical treatment should be considered for non-CBT.

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.

Results of surgical resection of carotid body tumors: A twenty-year experience.

This study examines whether surgical resection of carotid body tumors (CBTs) is acceptable in light of potential significant neurologic complications. This IRB-approved retrospective study analyzed data from 24 patients undergoing surgical treatment for CBTs between April 1998 and April 2017 at Mayo Clinic (Florida campus only). For patients who underwent multiple CBT resections, only data from the first surgery was used in this analysis. CBT resection occurred in 24 patients with the following demographics: fourteen patients (58.3%) were female, median age was 56.5 years, median BMI was 29. A prior history of neoplasm was found in ten patients (41.7%). A known family history of paraganglioma was present in five patients (20.8%). Two patients were positive for succinate dehydrogenase mutation (8.3%). Multiple paragangliomas were present in seven patients (29.2%). There was nerve sacrifice in three patients (12.5%) during resection. Carotid artery reconstruction and patch angioplasty occurred in one patient (4.2%). Complete resection occurred in 24 patients (100.0%). Postoperatively, one patient (4.2%) suffered stroke. No mortalities occurred within or beyond 30 days of surgery. Persistent cranial nerve injury occurred in two patients (8.3%) with vocal cord paralysis. There was no recurrence of CBT through last follow-up. Five patients (20.8%) were diagnosed with other neoplasms after resection, including basal cell carcinoma, contralateral carotid body tumor, glomus vagale, and glomus jugulare. There was 100% survival at 1 year in patients followed for that time (n = 17). Surgical treatment remains the first-line curative treatment to relieve symptoms and ensure non-recurrence. While acceptable, neurologic complications are significant and therefore detailed preoperative informed consent is mandatory.

Surgical Versus Sequential Hybrid Treatment of Carotid Body Tumors.

Carotid body tumor (CBT) are slow-growing tumors that develop in the cervical region at the carotid bifurcation. . In a randomized study, 33 patients were treated for CBT excision: 10 patients performed preoperative embolization (PE) and 23 were treated only by isolated traditional surgery (N-PE). The first group includes patients undergoing preoperative embolization. The second group of patients (N-PE) included 11 males and 12 females. Intraoperative complications were lower in patients treated with a hybrid procedure (PE): sections of the cranial nerves were recorded in 7% of cases compared to 12% of the surgical procedure (P-value = 0.72); while the reversible nerve lesions (P value = 0.21) and the permanent ones (P value = 0.46), were instead similar in both procedures. The comparative blood loss during the operative procedure shows a P-value of 0.02. Operating times, reversible damage of the cranial nerves , incidence of stroke (0% vs1%, P value> 0.99) and post-operative hospital stay (4.1 vs. 4.2 days, P value = 0.91) did not show differences in the two groups of patients. The analysis of the results detects pre-operative embolization of CBT in reducing intraoperative blood loss and resection of the cranial nerves..

Outcome of Surgical Treatment for Carotid Body Tumors in Different Shambling Type Without Preoperative Embolization: A Single-Center Retrospective Study

Carotid body tumor (CBT) is the most common head and neck paragangliomas. Surgical resection is the golden standard management for CBT. While preoperative embolization is still controversial, long-term outcomes and perioperative results are still deficient. We, here, presented the outcomes of surgical treatment for CBT without preoperative embolization at our institution. In this retrospective study, we collected data from 101 patients who received surgical treatment for CBTs without preoperative embolization from 2011 to 2016. In addition, we attempted to conduct 2years of follow-up under the guidance of both neurologist and vascular surgeon. Patients' demographics, clinical characteristics, complications, and follow-up results were all analyzed with descriptive statistics. Complete resection of the CBT was achieved in 101 cases (100%). Postoperative adverse events (AEs) mostly observed during hospitalization were as follows: tongue bias (I:4, 36.4%; II: 8, 19.5%; III: 13, 26.5%), hoarseness (I: 1, 9.1%; II: 4, 9.8%; III: 7, 14.3%), dysphagia (I: 0; II: 2, 4.9%; III: 7, 14.3%), and hematoma (I: 0; II: 0; III: 1, 2.0%). No other serious AEs were observed. The total incidence of AEs in type I patients was 5 (45.5%), 14 (34.1%) in type II, and 28 (57.1%) in type III, and the type III group has significantly higher than the other two groups. At the end of 2years of follow-up, there were no AEs in type I patients. The number of patients with AEs in type III was greater than that in type II, although there was no significant difference. Based on our findings, 3 most commonly injured cranial nerves (CNs) after surgical resection of CBT were CN XII (hypoglossal nerve, 21.9%), CN X (vagus nerve, 20.3%), and recurrent laryngeal nerve (18.8%). Surgical management without preoperative embolization for CBT patients is a safe and effective therapeutic approach.