Carotid body tumors: a subject review and suggested surgical approach

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✓ Carotid body tumors are a rare but potentially difficult surgical entity. Their pathology, physiology, and natural history are reviewed along with surgical results reported in the literature. A surgical approach for removal of these tumors is presented which differs significantly from the recommended techniques in that emphasis is placed on intraoperative monitoring of cerebral blood flow, the selective use of shunts, a tumor-adventitial plane of dissection, preservation of the carotid artery complex, and mobilization of the parotid gland. Thirteen cases using these techniques are reviewed. The mortality rate and the incidence of cerebrovascular sequelae were both 0%. The major morbidity consisted of injury to the lower cranial nerves in five patients (39%) with tumors larger than 5 cm in length.

Article Information

Address reprint requests to: Thoralf M. Sundt, Jr., M.D., Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905.

© AANS, except where prohibited by US copyright law.

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Figures

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    Surgical specimen of a carotid body tumor. Typical nests of epithelioid chief cells (“Zellballen”) with interlacing vascularized connective tissue. H & E, × 100. (Published with permission from H. Okazaki, M.D.)

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    Autopsy specimen of a carotid body tumor. Note that the internal and external carotid arteries are displaced laterally around the tumor with widening of the bifurcation. (Published with permission from H. Okazaki, M.D.)

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    Left: Classic angiographic pattern with widening of the bifurcation and stretching of the external and internal carotid arteries by a highly vascular carotid body tumor. Right: Postoperative angiogram demonstrates good flow through both the external and internal carotid arteries after tumor removal.

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    Angiograms showing a large carotid body tumor extending to the base of the skull (left), and receiving a significant blood supply from muscular branches of the vertebral artery (right).

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    Contrast-enhanced computerized tomography scan demonstrating erosion of the petrous bone and extension of a carotid body tumor into the cerebellopontine angle (arrow).

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    Operative sequence. Upper Left: The parotid gland has already been mobilized and the rostral extent of the tumor delineated. The common facial vein is often incorporated into the tumor capsule and must be ligated. Upper Right: After dissection of the medial and lateral borders of the tumor from the surrounding tissue, its attachments to the common carotid and external carotid arteries are attacked with bipolar cautery. Center Left: The tumor is dissected from the arteries in an areolar plane between the capsule and adventitia. Only its origin from the adventitia is removed in the subadventitial plane. Bipolar cautery is used to coagulate the multiple perforating branches from the vasa vasorum. Center Right: The superior and lateral poles of the tumor are further mobilized after the main blood supply to the tumor has been ligated. Lower: As a last step, the posterior wall of the tumor is dissected from the carotid artery complex and the cranial nerves. Rotation of the tumor improves exposure at this interface.

References

  • 1.

    Amir-Jahed AK: A simple method for resection of tumors of the carotid body. Surg Gynecol Obstet 143:8078081976Amir-Jahed AK: A simple method for resection of tumors of the carotid body. Surg Gynecol Obstet 143:807–808 1976

  • 2.

    Arias-Stella J: Human carotid body at high altitudes. Am J Pathol 55:82a1969 (Abstract)Arias-Stella J: Human carotid body at high altitudes. Am J Pathol 55:82a 1969 (Abstract)

  • 3.

    Borges LFHeros RCDeBrun G: Carotid body tumors managed with preoperative embolization. Report of two cases. J Neurosurg 59:8678701983Borges LF Heros RC DeBrun G: Carotid body tumors managed with preoperative embolization. Report of two cases. J Neurosurg 59:867–870 1983

  • 4.

    Brown JWBurton RCDahlin DC: Chemodectoma with skeletal metastasis: report of two cases. Mayo Clin Proc 42:5515551967Brown JW Burton RC Dahlin DC: Chemodectoma with skeletal metastasis: report of two cases. Mayo Clin Proc 42:551–555 1967

  • 5.

    Byrne JJ: Carotid body and allied tumors. Am J Surg 95:3713841958Byrne JJ: Carotid body and allied tumors. Am J Surg 95:371–384 1958

  • 6.

    The carotid bodies in oxygen regulation. Lancet 1:79801972 (Editorial)The carotid bodies in oxygen regulation. Lancet 1:79–80 1972 (Editorial)

  • 7.

    Carpenter MB: Human Neuroanatomyed 7. Baltimore: Williams & Wilkins1976 pp 345347Carpenter MB: Human Neuroanatomy ed 7. Baltimore: Williams & Wilkins 1976 pp 345–347

  • 8.

    Chambers RGMahoney WD: Carotid body tumors. Am J Surg 116:5545581968Chambers RG Mahoney WD: Carotid body tumors. Am J Surg 116:554–558 1968

  • 9.

    Chedid AJao W: Hereditary tumors of the carotid bodies and chronic obstructive pulmonary disease. Cancer 33:163516411974Chedid A Jao W: Hereditary tumors of the carotid bodies and chronic obstructive pulmonary disease. Cancer 33:1635–1641 1974

  • 10.

    Chung WB: The carotid body tumour. Can J Surg 22:3193221979Chung WB: The carotid body tumour. Can J Surg 22:319–322 1979

  • 11.

    Conley JJ: The carotid body tumor. A review of 29 cases. Arch Otolaryngol 81:1871931965Conley JJ: The carotid body tumor. A review of 29 cases. Arch Otolaryngol 81:187–193 1965

  • 12.

    Connell J: Carotid body tumours. Aust NZ J Surg 47:4955001977Connell J: Carotid body tumours. Aust NZ J Surg 47:495–500 1977

  • 13.

    Davidge-Pitts KJPantanowitz D: Carotid body tumors. Surg Annu 16:2032271984Davidge-Pitts KJ Pantanowitz D: Carotid body tumors. Surg Annu 16:203–227 1984

  • 14.

    Dent TLThompson NWFry WJ: Carotid body tumors. Surgery 80:3653721976Dent TL Thompson NW Fry WJ: Carotid body tumors. Surgery 80:365–372 1976

  • 15.

    Dockerty MBLove JGPatton MM: Nonchromaffin paraganglioma of the middle ear: report of a case in which the clinical aspects were those of a brain tumor. Proc Staff Meet Mayo Clin 26:25321951Dockerty MB Love JG Patton MM: Nonchromaffin paraganglioma of the middle ear: report of a case in which the clinical aspects were those of a brain tumor. Proc Staff Meet Mayo Clin 26:25–32 1951

  • 16.

    Farr HW: Carotid body tumors: a 40-year study. CA 30:2602651980Farr HW: Carotid body tumors: a 40-year study. CA 30:260–265 1980

  • 17.

    Fries JGChamberlin JA: Extra-adrenal pheochromocytoma: literature review and report of a cervical pheochromocytoma. Surgery 63:2682791968Fries JG Chamberlin JA: Extra-adrenal pheochromocytoma: literature review and report of a cervical pheochromocytoma. Surgery 63:268–279 1968

  • 18.

    Gaylis HMieny CJ: The incidence of malignancy in carotid body tumours. Br J Surg 64:8858891977Gaylis H Mieny CJ: The incidence of malignancy in carotid body tumours. Br J Surg 64:885–889 1977

  • 19.

    Gooding GAW: Gray-scale ultrasound detection of carotid body tumors. Report of two cases. Radiology 132:4094101979Gooding GAW: Gray-scale ultrasound detection of carotid body tumors. Report of two cases. Radiology 132:409–410 1979

  • 20.

    Gordon-Taylor G: On carotid tumours. Br J Surg 28:1631721940Gordon-Taylor G: On carotid tumours. Br J Surg 28:163–172 1940

  • 21.

    Grabowski EWPilcher DBSchmidek HHet al: Carotid body tumors. Am Surg 49:4834861983Grabowski EW Pilcher DB Schmidek HH et al: Carotid body tumors. Am Surg 49:483–486 1983

  • 22.

    Gratiot JH: Carotid-body tumors. Collective review. Int Abst Surg 77:1771861943Gratiot JH: Carotid-body tumors. Collective review. Int Abst Surg 77:177–186 1943

  • 23.

    Grufferman SGillman MWPasternak LRet al: Familial carotid body tumors: case report and epidemiological review. Cancer 46:211621221980Grufferman S Gillman MW Pasternak LR et al: Familial carotid body tumors: case report and epidemiological review. Cancer 46:2116–2122 1980

  • 24.

    Harrington SWClagett OTDockerty MB: Tumors of the carotid body. Clinical and pathological considerations of twenty tumors affecting nineteen patients (one bilateral). Ann Surg 114:8208331941Harrington SW Clagett OT Dockerty MB: Tumors of the carotid body. Clinical and pathological considerations of twenty tumors affecting nineteen patients (one bilateral). Ann Surg 114:820–833 1941

  • 25.

    Irons GBWeiland LHBrown WL: Paragangliomas of the neck: clinical and pathological analysis of 116 cases. Surg Clin North Am 57:5755831977Irons GB Weiland LH Brown WL: Paragangliomas of the neck: clinical and pathological analysis of 116 cases. Surg Clin North Am 57:575–583 1977

  • 26.

    Javid HChawla SKDye WSet al: Carotid body tumor. Resection or reflection. Arch Surg 111:3443471976Javid H Chawla SK Dye WS et al: Carotid body tumor. Resection or reflection. Arch Surg 111:344–347 1976

  • 27.

    Krupski WCEffeney DJEhrenfeld WKet al: Cervical chemodectoma. Technical considerations and management options. Am J Surg 144:2152201982Krupski WC Effeney DJ Ehrenfeld WK et al: Cervical chemodectoma. Technical considerations and management options. Am J Surg 144:215–220 1982

  • 28.

    Kumar AJKaufman SLPatt Jet al: Preoperative embolization of hypervascular head and neck neoplasms using microfibrillar collagen. AJNR 3:1631681982Kumar AJ Kaufman SL Patt J et al: Preoperative embolization of hypervascular head and neck neoplasms using microfibrillar collagen. AJNR 3:163–168 1982

  • 29.

    Lack EECubilla ALWoodruff JMet al: Paragangliomas of the head and neck region. A clinical study of 69 patients. Cancer 39:3974091977Lack EE Cubilla AL Woodruff JM et al: Paragangliomas of the head and neck region. A clinical study of 69 patients. Cancer 39:397–409 1977

  • 30.

    Lahey FHWarren KW: A long term appraisal of carotid body tumors with remarks on their removal. Surg Gynecol Obstet 92:4814911951Lahey FH Warren KW: A long term appraisal of carotid body tumors with remarks on their removal. Surg Gynecol Obstet 92:481–491 1951

  • 31.

    Lees CDLevine HLBeven EGet al: Tumors of the carotid body. Experience with 41 operative cases. Am J Surg 142:3623651981Lees CD Levine HL Beven EG et al: Tumors of the carotid body. Experience with 41 operative cases. Am J Surg 142:362–365 1981

  • 32.

    Levit SASheps SGEspinosa REet al: Catecholaminesecreting paraganglioma of glomus-jugulare region resembling pheochromocytoma. N Engl J Med 281:8058111969Levit SA Sheps SG Espinosa RE et al: Catecholaminesecreting paraganglioma of glomus-jugulare region resembling pheochromocytoma. N Engl J Med 281:805–811 1969

  • 33.

    Marquez JFJames ECGardner RJ: The current status of chemodectomas. Am Surg 43:1511581977Marquez JF James EC Gardner RJ: The current status of chemodectomas. Am Surg 43:151–158 1977

  • 34.

    Martin CERosenfeld LMcSwain B: Carotid body tumors: a 16-year follow-up of seven malignant cases. South Med J 66:123612431973Martin CE Rosenfeld L McSwain B: Carotid body tumors: a 16-year follow-up of seven malignant cases. South Med J 66:1236–1243 1973

  • 35.

    McIlrath DCReMine WH: Carotid-body tumors. Surg Clin North Am 43:113511441963McIlrath DC ReMine WH: Carotid-body tumors. Surg Clin North Am 43:1135–1144 1963

  • 36.

    Oberman HAHoltz FSheffer LAet al: Chemodectomas (nonchromaffin paragangliomas) of the head and neck. A clinicopathologic study. Cancer 21:8388511968Oberman HA Holtz F Sheffer LA et al: Chemodectomas (nonchromaffin paragangliomas) of the head and neck. A clinicopathologic study. Cancer 21:838–851 1968

  • 37.

    Padberg FT JrCady BPerrson AV: Carotid body tumor. The Lahey Clinic experience. Am J Surg 145:5265281983Padberg FT Jr Cady B Perrson AV: Carotid body tumor. The Lahey Clinic experience. Am J Surg 145:526–528 1983

  • 38.

    Pettet JRWoolner LBJudd ES Jr: Carotid body tumors (chemodectomas). Ann Surg 137:4654771953Pettet JR Woolner LB Judd ES Jr: Carotid body tumors (chemodectomas). Ann Surg 137:465–477 1953

  • 39.

    Pryse-Davies JDawson IMPWestbury G: Some morphologic, histochemical, and chemical observations on chemodectomas and the normal carotid body, including a study of the chromaffin reaction and possible ganglion cell elements. Cancer 17:1852021964Pryse-Davies J Dawson IMP Westbury G: Some morphologic histochemical and chemical observations on chemodectomas and the normal carotid body including a study of the chromaffin reaction and possible ganglion cell elements. Cancer 17:185–202 1964

  • 40.

    Rangwala AFSylvia LCBecker SM: Soft tissue metastasis of a chemodectoma. A case report and review of the literature. Cancer 42:286528691978Rangwala AF Sylvia LC Becker SM: Soft tissue metastasis of a chemodectoma. A case report and review of the literature. Cancer 42:2865–2869 1978

  • 41.

    Rauch S: Protismetastase eines Paraganglioma jugularetympanicum. HNO 16:3143161968Rauch S: Protismetastase eines Paraganglioma jugularetympanicum. HNO 16:314–316 1968

  • 42.

    Robbins SLCotran RS: Pathologic Basis of Diseaseed 2. Philadelphia: WB Saunders1979 pp 14061407Robbins SL Cotran RS: Pathologic Basis of Disease ed 2. Philadelphia: WB Saunders 1979 pp 1406–1407

  • 43.

    Romanski R: Chemodectoma (non-chromaffinic paraganglioma) of the carotid body with distant metastases, with illustrative case. Am J Pathol 30:191954Romanski R: Chemodectoma (non-chromaffinic paraganglioma) of the carotid body with distant metastases with illustrative case. Am J Pathol 30:1–9 1954

  • 44.

    Rosen IBPalmer JAGoldberg Met al: Vascular problems associated with carotid body tumors. Am J Surg 142:4594631981Rosen IB Palmer JA Goldberg M et al: Vascular problems associated with carotid body tumors. Am J Surg 142:459–463 1981

  • 45.

    Rush BF Jr: Familial bilateral carotid body tumors. Ann Surg 157:6336361963Rush BF Jr: Familial bilateral carotid body tumors. Ann Surg 157:633–636 1963

  • 46.

    Sato TSaito HYoshinaga Ket al: Concurrence of carotid body tumor and pheochromocytoma. Cancer 34:178717951974Sato T Saito H Yoshinaga K et al: Concurrence of carotid body tumor and pheochromocytoma. Cancer 34:1787–1795 1974

  • 47.

    Scudder CL: Tumor of the intercarotid body. A report of one case, together with all cases in the literature. Am J Med Sci 126:3843891903Scudder CL: Tumor of the intercarotid body. A report of one case together with all cases in the literature. Am J Med Sci 126:384–389 1903

  • 48.

    Shamblin WRReMine WHSheps SGet al: Carotid body tumor (chemodectoma). Clinicopathologic analysis of 90 cases. Am J Surg 122:7327391971Shamblin WR ReMine WH Sheps SG et al: Carotid body tumor (chemodectoma). Clinicopathologic analysis of 90 cases. Am J Surg 122:732–739 1971

  • 49.

    Shugar MAMafee MF: Diagnosis of carotid body tumors by dynamic computerized tomography. Head Neck Surg 4:5185211982Shugar MA Mafee MF: Diagnosis of carotid body tumors by dynamic computerized tomography. Head Neck Surg 4:518–521 1982

  • 50.

    Staats EFBrown RLSmith RR: Carotid body tumors, benign and malignant. Laryngoscope 76:9079161966Staats EF Brown RL Smith RR: Carotid body tumors benign and malignant. Laryngoscope 76:907–916 1966

  • 51.

    Sundt TM JrSharbrough FWPiepgras DGet al: Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy, with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc 56:5335431981Sundt TM Jr Sharbrough FW Piepgras DG et al: Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc 56:533–543 1981

  • 52.

    Tu HBottomley RH: Malignant chemodectoma presenting as a miliary pulmonary infiltrate. Cancer 33:2442491974Tu H Bottomley RH: Malignant chemodectoma presenting as a miliary pulmonary infiltrate. Cancer 33:244–249 1974

  • 53.

    van Asperen de Boer FRSTerpstra JLVink M: Diagnosis, treatment and operative complications of carotid body tumours. Br J Surg 68:4334381981van Asperen de Boer FRS Terpstra JL Vink M: Diagnosis treatment and operative complications of carotid body tumours. Br J Surg 68:433–438 1981

  • 54.

    Westbrook KCGuillamondegui OMMedellin Het al: Chemodectomas of the neck. Selective management. Am J Surg 124:7607661972Westbrook KC Guillamondegui OM Medellin H et al: Chemodectomas of the neck. Selective management. Am J Surg 124:760–766 1972

  • 55.

    Wright DJPandya ANoel F: Anaesthesia for carotid body tumour resection. A case report and review of the literature. Anaesthesia 34:8068081979Wright DJ Pandya A Noel F: Anaesthesia for carotid body tumour resection. A case report and review of the literature. Anaesthesia 34:806–808 1979

  • 56.

    You-xian FQun S: Surgical treatment of carotid body tumors. Review of 63 cases. Chin Med J 95:4174221982You-xian F Qun S: Surgical treatment of carotid body tumors. Review of 63 cases. Chin Med J 95:417–422 1982

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