Carotid Body Tumours: A Review

Abstract

The carotid body is a small structure weighing 12 mg located in the adventitia of carotid artery bifurcation acting as a chemoreceptor. Carotid body tumour (CBT); formerly known as chemodectoma is a rare, highly vascular, mostly benign tumour arising from the paraganglia of carotid body; hence, the name (carotid paraganglioma). The high vascularity and proximity to cranial nerves and major vessels make this tumour a surgical challenge. Abundant literature has been written about CBT in the last century with a continuous debate regarding its etiology, natural history, biological behavior, proper technique of excision, and the morbidity and mortality associated with its resection. The purpose of this review article is to simplify understanding the basic and clinical aspects of this challenging neoplasm.

Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation

“…Most of them are sporadic and about 10% of them are familial. Interestingly they are more frequent in population living in high altitudes and this has suggested that they represent an extreme form of hyperplasia of carotid sinus cells due to chronic hypoxia [ 59 , 61 ].…”

“…Preoperative definition of the anatomy with all possible radiological means, including computerized tomographic arteriography, seems a cardinal factor for success. Disease progression is usually slow allowing a good prognosis [ 61 ].…”

Carotid body paraganglioma

“…[8] It consists of two types of cells: chief cells and sustentacular cells which are derived from neural crest cells and neuroectoderm, respectively. [9] The tumors arising from the chief paraganglial cells are termed as paragangliomas and accounts for about 0.5% of all tumors. It accounts for 1 out of 30,000 head and neck tumors cases with 65% occurring in the carotid body region and are termed as CBP.…”

Surgical Resection of Painless Carotid Body Tumour without Preoperative Embolization: A Case Report and Review of Literature

“…The embryologic origin is from the third branchial arch and contains homeostatic chemoreceptor cells-the sensory nerve endings of the carotid sinus nerve penetrate the clusters to synapse with chemoreceptor cells [31][32][33][34][35][36][37]. The carotid body is made up of two types of cells, called glomus cells: glomus type I cells derived from the neural crest, and glomus type II cells and act as supporting cells [38][39][40][41][42][43][44][45][46][47]. The glomus or type I cells of the CB are the transducers of hypoxic stimuli, and relay chemosensory information to the brainstem via neurotransmitter release at synaptic contacts with afferent terminals of the carotid sinus nerve.…”

“…Some authors suggest that ligation of the external carotid artery provides a safe opportunity for operation in cases with larger tumors that are densely adherent to the carotid artery [45]. The ligation of the ICA must be avoided if possible because of the 66% prevalence of stroke [46]. The surgical technique must perform precise anatomic dissection and vascular control before the tumor excision.…”