Resection of Carotid-Body Jumors with Preservation of the Carotid Vessels

Successful Resection of a Large Carotid Body Tumor Masquerading Complete Encasement of the Internal Carotid Artery on Preoperative Imaging

“…In the literature, dizziness, headache, syncope, tinnitus, vertigo, local tenderness, or pain have all been reported as being related to CBTs. 5,8,9,13 –16 However, with the exception of syncope, there is no report of patient symptoms being cured after CBT resection, indicating that they may have been innocent bystanders, unrelated to the tumor itself, although our case suggests the contrary. Interestingly, only 3 cases with intraoperative arrest during CBT resection, like in our case, have been reported, 17 –19 thought to be the result of carotid sinus sensitivity, the so-called carotid sinus syndrome.…”

“…An inappropriate dissection plane may explain the high rate of inadvertent injury of the ICA reported by 2 recent studies. 2,7 Some authorities have suggested that CBTs can “practically always be excised without resection of the carotid bifurcation.” 8 It has been suggested that a CBT may be longitudinally incised and carefully dissected from the arterial medial layer 9,10 ; however, extensive subadventitial dissection is nowadays not advised to avoid pseudoaneurysm formation, so that carotid replacement or repair is still required in certain cases, about 10% of all patients in large series. 5 An additional point that merits discussion is the small—12 mm—distance of the upper part of the tumor from the base of the skull, recently shown to be associated with an increased risk of bleeding and cranial nerve injury, none encountered in our case.…”

Tumores do corpo carotídeo: revisão de oito casos e abordagem cirúrgica

“…2 -Exposição distal dos tumores muito volumosos através de mobilização da parótida. 3 -Os tumores devem ser dissecados em um plano capsular-adventicial em oposição ao plano sub-adventicial proposto por vários cirurgiões 5,[9][10][11]24,25 ; esse plano de dissecção é desenvolvido utilizando-se a coagulação bipolar e o microscópio cirúrgico, o que minimiza o risco de lesão arterial e hemorragia. 4 -Um grande esforço deve ser feito para manter a integridade da artéria carótida externa, pois ela é fonte potencial de fluxo colateral; este conceito é contrário a opinião de vários autores que, às vezes, iniciam a cirurgia pela ligadura da carótida externa 5,11,26 .…”

Carotid Body Tumors – Idiosyncracies

“…Bruit and thrill were not clearly present or specifically diagnostic in any patient, and it was difficult to determine whether pulsation was transmitted or not. Although it has been stated that on palpation carotid body tumors can be moved horizontally, that is, side to side [6,14,15], and not vertically or up and down, such a sign was of little help in diagnosis. Often, adherence of the tumor to the surrounding tissues precludes much, if any, mobility.…”

“…G o r d o n -T a y l o r [8] has written of this characteristic and termed it the 'white line' or cleavage plane between tumor and vessel. F a r r a r et al [6] later expounded on this feature and felt that almost all carotid body tumors were amenable to resection. He recommended that if the tumor could not be dissected free from the media intact, it be split on its anterior aspect enabling it to be removed from the vessel which it encircles.…”