Carotid Body Tumor

Historical Background

Reigner performed the first carotid body tumor (CBT) resection in 1880, though the patient did not survive. In 1889 Albert became the first to excise a CBT without cranial nerve or carotid artery injury, and Scudder was the first to do so in the United States in 1903. Though the days when “many of the contributions to the literature…are based upon a solitary case” have passed, these tumors are still quite rare and most vascular surgeons encounter few in their career. Earlier diagnosis, improvements in technology and technique, and advances in intraoperative management contribute to low perioperative mortality. Despite this, morbidity because of cranial nerve dysfunction remains a concern.

Preoperative Preparation

• Duplex ultrasound scans show a highly vascular mass that widens the carotid bifurcation. Concomitant carotid occlusive disease may be identified in patients at risk of atherosclerosis.

• Fine needle aspiration or open biopsy of a suspected CBT are contraindicated because of the risks of hemorrhage or injury to the carotid artery.

• Computed tomography (CT) and magnetic resonance imaging (MRI) scanning can be used to identify a CBT and estimate its size and extent. Proximity to other vital neck structures can be ascertained. CT scanning is particularly valuable in demonstrating the presence or absence of a plane between the internal carotid artery (ICA) and the tumor. CT may assist in the preoperative assessment as to whether the tumor can be removed without disruption of the ICA. Both CT and MRI scanning are useful in determining bilaterality, which occurs in approximately 5% of patients.

• Angiography demonstrates the tumor’s blood supply and its relationship to neighboring vascular structures. CT angiography may be preferred over conventional angiography because of the lack of embolic risk. However, angiography has been used in conjunction with peroperative embolization of large tumors and balloon occlusion testing to determine whether the ICA can be ligated during resection, if required and reconstruction is not possible.

• Prophylactic antibiotics should be administered. Invasive arterial blood pressure monitoring and intraoperative cerebral monitoring are recommended.

Pitfalls and Danger Points

• Cranial nerve injury is the most common complication and occurs most often with larger tumors.

• Stroke

• Hematoma

• Horner syndrome

• First bite syndrome

• Baroreflex failure

Operative Strategy