Managing Large Carotid Body Tumors-AIIMS Experience

Objectives: The purpose of this retrospective study is to share our experience in the management of large- and mega-size CBT problems encountered during surgery and how these problems were managed. The emphasis is on preventing complications and improving quality of life in mega-size CBTs where the upper end of the ICA cannot be accessed.

Study Design: Retrospective chart review.

Setting: Tertiary care center.

Subject and Methods: Twenty-four patients with 25 carotid body tumors were operated on. Data in terms of age, sex, duration of symptoms, laterality of the tumor, radiological findings, lower cranial nerve palsies, preoperative embolization, intraoperative findings, intraoperative blood loss, ligation of carotid vessels, postoperative cranial nerve palsy, and duration of hospital stay were recorded. Shamblin’s classification system was used to designate the tumor stage. In larger tumors, preoperative complete occlusion of distal ICA and maintaining cerebral perfusion for 5 days before surgery were done.

Results: According to the Shamblin’s classification, 18 (72%) tumors were type II and 7 (28%) were type III. Twenty-three patients (92%) were operated on successfully in terms of complete tumor removal. Intraoperative ligation of CCA was done in three (12%), ICA in one, and ECA in nine (36%) cases. Mean intraoperative blood loss was 283 mL (range, 40 mL-2 L). Postoperatively, cranial nerve palsy was seen in five patients (20%). Mean duration of hospital stay was 17.8 days (range of 7-43 days).

Conclusion: Complete excision of tumor with preservation of neurovascular structures is the primary therapeutic option for carotid body tumors. Preoperative assessment of cross-cerebral circulation, meticulous preoperative planning, and a multidisciplinary team approach lead to successful outcome with reduced postoperative morbidity.