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

Abstract

A 41-year-old woman presented with a large painful and tender mass of the left side of her neck located just below the angle of the mandible. She was also complaining of frequent attacks of symptoms ranging from dizziness upon resuming the erect position to frank syncope. Color-coded duplex showed a large well-vascularized vascular mass at the level of the carotid bifurcation, suggesting the diagnosis of a carotid body tumor (CBT). A computerized tomographic angiography confirmed the diagnosis of a CBT, which measured 5.7 cm in its craniocaudal axis. The tumor appeared to encase the internal carotid artery (ICA) at the level of its origin, indicating the presence of a Shamblin group 3 tumor. During surgery, the CBT seemingly encased the ICA; however, it was successfully taken off the ICA, by establishing an adventitial dissection place, obviating the need for arterial resection and replacement. A brief intraoperative episode of cardiac arrest was successfully managed. Postoperative course was uneventful, and all symptoms were cured. Pathology confirmed the clinical diagnosis and did not show malignancy. In conclusion, meticulous surgical techniques can spare the ICA from removal or inadvertent injury during CBT surgery and reduce the morbidity often associated with the resection of large or advanced tumors but also cure atypical patient symptoms.

Case report: Cardiac arrest during carotid body tumor resection indicating carotid sinus hypersensitivity

“…Surgical CBT management can lead to various complications, including cranial nerve injury, vascular injury, stroke, and intraoperative blood loss. However, sudden cardiac arrest during CBT manipulations experienced by the patient described in the present report is very rare, with no more than 10 cases reported to date (7,8). This complication can be attributed to CSH.…”

Carcinoma del glomus carotideo. Serie de casos

“…y liberando la bifurcación carotidea7,10,21,22 . La técnica retro-carotidea también se ha descrito en el abordaje de estos tumores, especialmente en los malignos, implicando la resección de la arteria carótida externa con posterior reconstrucción, usualmente usando injertos de vena safena.…”