Carotid body tumors: A review of 30 patients with 46 tumors

Abstract

Minimal morbidity occurs with resection of most carotid body tumors (CBT). With larger tumors significant injury to the cranial nerves has been reported. In order to assess the operative sequelae rate, 30 patients with CBT were reviewed. Sixteen patients either presented with bilateral carotid body tumors or had previously undergone a resection of the contralateral carotid body tumors, for a total carotid body tumor count of 46. Sixteen patients demonstrated a familial pattern while 14 were nonfamilial. Within the familial group, 14 of 16 presented with multiple paragangliomas as compared to 6 of 14 in the nonfamilial group. Tumor size ranged from 0.8 to 12 cm. Vascular replacement occurred in 2 of 20 patients with tumors < 5.0 cm, compared with 5 of 9 with tumors > 5.0 cm. Four patients lost cranial nerves with the resection: superior laryngeal nerve (SLN), 4; cranial nerve X, 1; cranial nerve XII, 1. Ten patients developed baroreceptor failure secondary to bilateral loss of carotid sinus function. First-bite pain occurred in 10 of 25 operative patients. Cranial nerve loss can be minimal with resection of carotid body tumors, however, baroreceptor failure and first-bite pain are postoperative sequelae that are often disregarded in the postoperative period.

Carotid Body Tumors: A Review of 25 Years Experience in Diagnosis and Management of 56 Tumors

“…Since most of the Shamblin's III cases included in this study could be considered as class IIIa, it was expected to have some of them successfully excised without vascular resection. The distinction between vascular encasement and vascular infiltration should be clear when interpreting the outcomes of resection of Shamblin III makes precise periadventitial dissection more difficult 28) and the risk of intracranial embolization. 20) Also it did not affect the probability of need for vascular repair.…”

A morphological study on the carotid body of the Angora rabbit

“…Type I cells (also called glomus or epitheloid cells), measure changes in blood pressure and the composition of arterial blood flowing past them, including the partial pressures of oxygen and carbon dioxide and are also sensitive to changes in blood temperature and pH, suggesting that they are secretory cells. [7][8] The type II cells (also called sustentacular or supporting cells) resemble glial cells of the nervous system. 9 Previous investigation showed that the carotid bodies enlarge in cattle, guinea-pigs and rabbits living in the hypobaric hypoxia of high altitude to which they have to acclimatize.…”

Tumor de corpo carotídeo (paraganglioma): relato de dois casos submetidos a tratamento cirúrgico

“…10 During the procedure, before dissection, it is very important to identify and fully expose all nerves, avoiding excessive handling. 5,23 In certain situations, such as resection en bloc or a possible injury to the artery wall, it will be necessary to construct a shunt. 17 Barbiturates and mannitol are recommended if it is necessary to clamp the internal carotid artery.…”

“…25 The greatest cause of morbidity is injury to the cranial pairs, of which the hypoglossal, vagus and laryngeal superior are the most often affected, which can cause paralysis that is very often definitive. 4,17,18,23 More serious complications, such as strokes and difficult to control hemorrhages, are rarer. 4 Embolization can be employed in cases of large tumors, which will reduce blood loss and the size of the tumor and improve the results of surgery, but the risk of cerebral embolism cannot be ruled out.…”