Multidisciplinary management of carotid body tumors: a single-institution case series of 22 patients

Alexander RamosDepartments of Neurological Surgery,
Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York

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Joseph A. CarnevaleDepartments of Neurological Surgery,
Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York

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Kashif MajeedDepartments of Neurological Surgery,

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Gary KocharianDepartments of Neurological Surgery,
Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York

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Ibrahim HussainDepartments of Neurological Surgery,

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Jacob L. GoldbergDepartments of Neurological Surgery,

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Justin SchwarzDepartments of Neurological Surgery,
Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York

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David I. KutlerOtolaryngology, Head and Neck Surgery, and

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Jared KnopmanDepartments of Neurological Surgery,
Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York

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Philip StiegDepartments of Neurological Surgery,

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OBJECTIVE

Carotid body tumors (CBTs) are rare, slow-growing neoplasms derived from the parasympathetic paraganglia of the carotid bodies. Although inherently vascular lesions, the role of preoperative embolization prior to resection remains controversial. In this report, the authors describe an institutional series of patients with CBT successfully treated via resection following preoperative embolization and compare the results in this series to previously reported outcomes in the treatment of CBT.

METHODS

All CBTs resected between 2013 and 2019 at a single institution were retrospectively identified. All patients had undergone preoperative embolization performed by interventional neuroradiologists, and all had been operated on by a combined team of cerebrovascular neurosurgeons and otolaryngology–head and neck surgeons. The clinical, radiographic, endovascular, and perioperative data were collected. All procedural complications were recorded.

RESULTS

Among 22 patients with CBT, 63.6% were female and the median age was 55.5 years at the time of surgery. The most common presenting symptoms included a palpable neck mass (59.1%) and voice changes (22.7%). The average tumor volume was 15.01 ± 14.41 cm3. Most of the CBTs were Shamblin group 2 (95.5%). Blood was predominantly supplied from branches of the ascending pharyngeal artery, with an average of 2 vascular pedicles (range 1–4). Fifty percent of the tumors were embolized with more than one material: polyvinyl alcohol, 95.5%; Onyx, 50.0%; and N-butyl cyanoacrylate glue, 9.1%. The average reduction in tumor blush following embolization was 83% (range 40%–95%). No embolization procedural complications occurred. All resections were performed within 30 hours of embolization. The average operative time was 173.9 minutes, average estimated blood loss was 151.8 ml, and median length of hospital stay was 4 days. The rate of permanent postoperative complications was 0%; 2 patients experienced transient hoarseness, and 1 patient had medical complications related to alcohol withdrawal.

CONCLUSIONS

This series reveals that endovascular embolization of CBT is a safe and effective technique for tumor devascularization, making preoperative angiography and embolization an important consideration in the management of CBT. Moreover, the successful management of CBT at the authors’ institution rests on a multidisciplinary approach whereby endovascular surgeons, neurosurgeons, and ear, nose, and throat–head and neck surgeons work together to optimally manage each patient with CBT.

ABBREVIATIONS

BTO = balloon test occlusion; CBT = carotid body tumor; CCA = common carotid artery; EBL = estimated blood loss; ECA = external carotid artery; EVOH = ethylene vinyl alcohol; ICA = internal carotid artery; NBCA = N-butyl cyanoacrylate; PVA = polyvinyl alcohol; TIA = transient ischemic attack.
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Figure from Ramos et al. (pp 95–103).

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