Surgical treatment of carotid body tumor: case report and literature review

Low red blood cell predicts high risk of temporary postoperative complications after carotid body tumor surgical resection

Background

Carotid body tumor (CBT) is a rare paraganglioma located at the carotid bifurcation. The red blood cell count, hemoglobin, and hematocrit are indexes to be evaluated in blood routine tests. The purpose of this study was to clarify their predictive value for temporary postoperative complications in patients that had undergone CBT surgery.

Methods

This retrospective trial included data from 169 patients received surgical treatment for CBT from October 2008 to September 2018 in this retrospective study. Postoperative follow-up was conducted under the guidance of both vascular surgeon and neurologist. The symptoms existed less than 2 years postoperatively were regarded as temporary injuries. The red blood cell count, hemoglobin, and hematocrit were obtained from the complete blood count results of the participants. Analyses of multilevel multivariable regression and descriptive statistics were conducted.

Results

The baseline data showed no significant difference. Patients were predominantly women (53.8%), with a mean age of 42.6 years. The total incidence of temporary postoperative complications was 22 (13.0%), including transient ischemic attack (8, 4.7%), tongue bias (7, 4.1%), dysphagia (2, 1.2%), hoarseness (4, 1.8%), and eyelid ptosis (1, 2.4%). The univariate and multivariate regression analysis results revealed that the occurrence of temporary postoperative complications was increased with age [odd ratio (OR, 0.09; 95% CI (CI), 0.9–1.0; P = 0.014], length of operation time (OR, 1.0; 95% CI, 1.0–1.0; P = 0.005), Shamblin type II vs. I (OR, 0.1; 95% CI, 0.0–0.5; P = 0.008), red blood cell count postoperative (OR, 0.2; 95% CI, 0.1–0.8; P = 0.026), hemoglobin (OR, 0.9; 95% CI, 0.9–1.0; P = 0.011), and hematocrit (OR, 0.8; 95% CI, 0.7–1.0; P = 0.025). The smooth curve fitting showed that the trend of complications occurrence rate was reduced with the increase of patients’ postoperative red blood cell count, hemoglobin, and hematocrit. Gender, weight, length of operation, Shamblin type, postoperative red blood cell count, hemoglobin, and hematocrit were included in the risk model with AUC = 0.86.

Conclusion

These patients with CBT who received surgical resection with low postoperative red blood cell, hemoglobin, or hematocrit had a high risk of temporary postoperative complications. The risk prediction model established for predicting temporary postoperative complications showed satisfactory prediction effects.

Surgical Versus Sequential Hybrid Treatment of Carotid Body Tumors

Carotid body tumor (CBT) are slow-growing tumors that develop in the cervical region at the carotid bifurcation. . In a randomized study, 33 patients were treated for CBT excision: 10 patients performed preoperative embolization (PE) and 23 were treated only by isolated traditional surgery (N-PE). The first group includes patients undergoing preoperative embolization. The second group of patients (N-PE) included 11 males and 12 females. Intraoperative complications were lower in patients treated with a hybrid procedure (PE): sections of the cranial nerves were recorded in 7% of cases compared to 12% of the surgical procedure (P-value = 0.72); while the reversible nerve lesions (P value = 0.21) and the permanent ones (P value = 0.46), were instead similar in both procedures. The comparative blood loss during the operative procedure shows a P-value of 0.02. Operating times, reversible damage of the cranial nerves , incidence of stroke (0% vs1%, P value> 0.99) and post-operative hospital stay (4.1 vs. 4.2 days, P value = 0.91) did not show differences in the two groups of patients. The analysis of the results detects pre-operative embolization of CBT in reducing intraoperative blood loss and resection of the cranial nerves..

Carotid body tumor: a case report and literature review

The carotid body is the largest collection of paraganglia in the head and neck and is found on the medial aspect of the carotid bifurcation bilaterally. Carotid body tumors are rare neoplasms arising from the chemoreceptor cells of the carotid bulb. We report a case of carotid body tumor in a 42-year-old female, who presented with painless, pulsatile, gradually progressive lateral neck swelling. The diagnosis is suspected on the basis of history, clinical and radiological examination findings and a successful surgical excision of the tumor is performed. Histopathological examination confirms the diagnosis of carotid body tumor. We also present brief literature about carotid body tumors in terms of its clinical and imaging presentation, evaluation, and management.

Excision of rare carotid body tumour without preembolisation: Case report and literature review

INTRODUCTION

Carotid body tumors also known as parganglioma or chemodactomas are one of the rare tumors of head and neck which present as slow growing masses in the neck region. We present a case of 40 years female with painless slow growing mass over left side of her neck for 6 months. Diagnosis was made on basis of clinical history, examination and radiological findings. Tumor was graded as Shamblin grade II. She was managed with excision of the tumor without preoperative embolisation. Intraoperative and postoperative periods were uneventful.

CASE PRESENTATION

A forty years female presented with left sided painless neck swelling∼5 × 4 cm² over left anterior triangle for 6 months with no history of dysphagia, odynophagia, change in voice, shortness of breath, palpitations, tremors or syncopal attacks. She underwent USG neck and CT angiogram. Based upon the radiological and clinical findings, she was diagnosed asCarotid body tumor. She was managed with excision of the tumor without preembolisation. Her diagnosis was confirmed with histopathology.

CONCLUSION

Carotid body tumours are rare entities of head and neck region. They are mostly benign in nature. Though mostly bening, increasing size might result in grave complications. Thus, the recommended treatment for carotid body tumors is early excision with or without pre-embolisation. In our case preembolisation was not performed. Though some studies have suggested the use of preoperative embolisation in large sized tumors, more studies are yet required to justify the choice of preembolisation despite the dreaded complications.

Current conception of carotid chemodectoma and efficiency of its treatment methods

The review presents current data from foreign studies of a rare tumor — carotid chemodectoma, particularly, about its prevalence, classification, clinical presentation, applicability of different diagnostics methods, and also on efficiency of treatment of this disease and complications developing after it in terms of described clinical cases. Search for relevant sources was carried out in Medline, US National Library of Medicine, Elibrary systems, in Cochrane Library and peer-reviewed scientific journals. A total of 26 studies were found, 22 of them were included in the review. Carotid chemodectoma is most often characterized by benign course, but, because of its scarce clinical presentation, specific examination methods are required for its accurate diagnosis. Surgical resection is usually used for the treatment of carotid chemodectoma, and in case of contraindications for the surgery, radiotherapy is applied (as a palliative method). The most widespread complications after surgical treatment are cranial nerve damage, intraoperative bleeding and ischemic stroke. Several cases were described in literature, when scientists from different countries (USA, Korea) attempted to decrease risk of complications by use of preoperational embolization, but that led to new complications, particularly, to migration of embolic material. At the same time, scientists from Netherlands noted some decrease of the number of postoperative complications when craniocaudal method was used. To date the only effective method of treatment of carotid chemodectoma is still surgical resection, but it cannot be used in a broad variety of cases. Moreover, the world surgical practice has no effective techniques for prevention of different complications occurring in postoperative period, that reduces possibilities of successful patients’ recovery. Therefore, to decrease the rate of postoperative complications and to increase patients survival rate further studies are required.