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      Management of sizeable carotid body tumor: Case report and review of literature

      case-report

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          Abstract

          Carotid body tumor is a paraganglioma derived from the neural crest. It arises from the carotid body which acts as a vascular chemoreceptors and is usually located at the carotid bifurcation. Sizeable (Shamblin III, >5 cm size) tumors are large and typically encase the carotid artery requiring vessel resection and replacement. Management of such tumors carries a high risk of postoperative mortality and morbidity rates specially with regards to neurovascular complications. We report a case of sizeable tumor which was surgically removed with minimal complications.

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          Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases.

          W R Shamblin, W H ReMine, S G Sheps … (1971)
          Article 0 comments Cited 83 times – based on 0 reviews     Review now
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            A multicenter review of carotid body tumour management.

            M. Sajid, Laura M S Baker, Graham Hamilton … (2007)
            Carotid body tumour (CBT) is a rare but the most common form of head and neck paraganglioma (PGL). We present the biggest ever series on CBT in UK/EU discussing diagnostic challenges, surgical treatment and complications of surgical intervention. A detailed proforma was designed and sent to all members of Joint Vascular Research Group (JVRG). Data of 95 patients was collected. Generic terms including carotid body tumour/s, or paraganglioma/s were used to search a variety of electronic database in order to get latest informations available in literature. A total of 95 patients were recorded in our data from 1979 to 2005. Mean age of presentation was 55 years. Incidence was higher in females. CBT was more common on right side (58%). 18% tumours were bilateral. Neck lump (98%) and pressure symptoms including cranial nerve deficits and pain were main presenting complaints. About 18% of tumours were familial. Only 4.2% were malignant. Duplex scan is the best investigation for diagnosis, though MRI, DSA and CT scan are important for preoperative assessment. Surgery is the treatment of choice. Stroke and cranial nerve injury constitute postoperative morbidity (35%) and mortality (1%). Incidence of postoperative cranial nerve deficit was about 19%. Combined ipsilateral and contralateral recurrence rate was 4.2%. CBT is a rare condition which needs surgical excision by experienced vascular surgeon. Surgical resection is associated with significant morbidity of 35% and mortality of 1%. Mostly CBT is benign but malignant forms are not uncommon.
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              Combined endovascular and surgical treatment of head and neck paragangliomas--a team approach.

              Y Niimi, Avi Setton, Nicole S. Persky … (2002)
              Paragangliomas are highly vascular tumors of neural crest origin that involve the walls of blood vessels or specific nerves within the head and neck. They may be multicentric, and they are rarely malignant. Surgery is the preferred treatment, and these tumors frequently extend to the skull base. There has been controversy concerning the role of preoperative angiography and embolization of these tumors and the benefits that these procedures offer in the evaluation and management of paragangliomas. Forty-seven patients with 53 paragangliomas were treated from the period of 1990-2000. Initial evaluation usually included CT and/or MRI. All patients underwent bilateral carotid angiography, embolization of the tumor nidus, and cerebral angiography to define the patency of the circle of Willis. Carotid occlusion studies were performed with the patient under neuroleptic anesthesia when indicated. The tumors were excised within 48 hours of embolization. Carotid body tumors represented the most common paraganglioma, accounting for 28 tumors (53%). All patients underwent angiography and embolization with six patients (13%), demonstrating complications (three of these patients had embolized tumor involving the affected nerves). Cerebral angiography was performed in 28 patients, and 5 of these patients underwent and tolerated carotid occlusion studies. The range of mean blood loss according to tumor type was 450 to 517 mL. Postoperative cranial nerve dysfunction depended on the tumor type resected. Carotid body tumor surgery frequently required sympathetic chain resection (21%), with jugular and vagal paraganglioma removal frequently resulting in lower cranial nerve resection. These patients required various modes of postoperative rehabilitation, especially vocal cord medialization and swallowing therapy. The combined endovascular and surgical treatment of paragangliomas is acceptably safe and effective for treating these highly vascular neoplasms. Adequate resection may often require sacrifice of one or more cranial nerves, and appropriate rehabilitation is important in the treatment regimen. Copyright 2002 Wiley Periodicals, Inc.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Avicenna J Med
                Journal ID (iso-abbrev): Avicenna J Med
                Journal ID (publisher-id): AJM
                Title: Avicenna Journal of Medicine
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2231-0770
                ISSN (Electronic): 2249-4464
                Publication date (Print): Oct-Dec 2013
                Volume: 3
                Issue: 4
                Pages: 106-108
                Affiliations
                [1] Department of Surgery, University of Dammam, Al-Khobar, Kingdom of Saudi Arabia
                [1 ] Department of Radiology, University of Dammam, Al-Khobar, Kingdom of Saudi Arabia
                Author notes
                Address for correspondence: Dr. Mohamed A. Elsharawy, Professor Vascular Surgery, Al-Khobar - 31952, Eastern Province, Kingdom of Saudi Arabia. E-mail: elsharawya@ 123456yahoo.co.uk
                Article
                Publisher ID: AJM-4-106
                DOI: 10.4103/2231-0770.120503
                PMC ID: 3841480
                SO-VID: f0ab3280-0a25-4bb4-9aa2-ff33a7310d4c
                Copyright © Copyright: © Avicenna Journal of Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: carotid body tumor,shamblin,paraganglioma
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: carotid body tumor, shamblin, paraganglioma

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