Anesthetic approaches in carotid body tumor surgery

Preoperative Embolization in Surgical Resection of Cervical Paragangliomas: Usefulness and Current Evidence

BACKGROUND

Cervical paragangliomas (CPG) are slow-growing tumours, most of which are highly vascular, making surgical resection challenging. Preoperative embolisation of afferent arteries has been recommended to facilitate operative dissection, reduce perioperative blood loss, and shorten the duration of the operation. However, there is conflicting evidence on the benefits of preoperative embolisation on surgical outcomes, operative time, and bleeding.

OBJECTIVES

The objective of this study was to compare the perioperative parameters and outcomes like duration of surgery, blood transfusion, duration of stay in the ICU, cranial nerve injuries, and postoperative stroke between patients who underwent excision of CPGs with and without preoperative embolisation.

METHODS

This is a retrospective study conducted at the Division of Vascular Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. The study included a review of the medical records of 32 patients who underwent excision of CPGs. Patients who underwent surgical resection without preoperative embolisation (SR) were compared with those who underwent surgical resection with embolisation (SREMB). Statistical analysis was done in R statistical software (R Foundation for Statistical Computing, Vienna, Austria). Categorical variables were reported in absolute numbers and percentages continuous variables were compared with an unpaired Mann-Whitney U test. The chi-square test was used to compare the categorical data.

RESULTS

Out of 32 patients included in this study, 13 (40.6%) patients were included in the SREMB group. Between the two groups, there were no significant differences in operative time (120 vs. 150 minutes; p = 0.59), blood transfusion requirement (0.69 vs. 0.37 units; p = 0.39) and ICU stays (1 vs. 1; p = 0.56). Postoperative cranial nerve injury was significantly more in the SREMB group (6 vs 1; p = 0.01) but stroke (0 vs 2; p = 0.50) was not statistically significant between the two groups.

CONCLUSION

In this study, we found that there was insufficient evidence to support routine preoperative embolisation in CPG. Hence, preoperative embolisation should only be used in a very select group of patients.

Case Report: Managing a giant, high-grade carotid body tumor in a resource-limited setting

Herein we report the management of a giant, high-grade and vascular carotid body tumor in a young woman. She presented with slowly progressive neck swelling. Vascular imaging revealed a left-sided, high-grade giant carotid body tumor (> 8cm).  The tumor was completely excised by caudocranial subadventitial dissection. Histology of the tumor revealed a characteristic Zellballen pattern of the lesion, suggestive of a paraganglioma. The patient made an uneventful recovery. We also discuss newer insights regarding the management of such highly vascular lesions.