Clamping of external carotid artery rather than embolization during surgical removal of a huge carotid body tumor

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. The carotid body is a gland located behind the carotid artery at the site of its bifurcation on either sides of the neck and originates from the neural crest and acts as a peripheral chemoreceptor. Case Report: A 42-year-old female presented with progressively enlarging neck swelling over five years which was associated with a recent difficulty in swallowing and hoarseness of voice. On examination there was anterolateral pulsatile neck swelling, ovoid in shape, about 6×6×7 cm in size, mobile from side to side only and firm in consistency. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) showed a mass arising at the bifurcation of common carotid artery (CCA), which has rich blood supply, splaying the external carotid artery (ECA). Blood test for vanillylmandelic acid (VMA) was negative. The patient underwent surgical excision of the tumor through an endarterectomy approach after clamping of the ECA. We report this case where clamping of ECA is being applied rather than endovascular embolization of the feeding vessels to minimize bleeding during removal of the tumor, to avoid embolization related complications and to lessen the cost of the procedure. Conclusion: Carotid body tumors are rare, however, early diagnosis and prompt treatment is essential. In a large tumor, preoperative endovascular embolization is widely used for devascularization. Clamping of the external carotid artery is a good alternative way to avoid embolization related complication with better control of bleeding, less operative time and improved cost-effectiveness.