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Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 133 - 135
Surgical Management and Outcomes of Carotid Body Tumors: A Retrospective Analysis and Training Perspective.
 ,
1
Additional Prof, CVTS Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P., India
2
Director (Neurosurgery) Institute of Neurosciences, Medanta Hospital, Lucknow, U.P., India
Under a Creative Commons license
Open Access
Received
Nov. 20, 2024
Revised
Dec. 3, 2024
Accepted
Dec. 24, 2024
Published
Jan. 14, 2025
Abstract

Background Carotid body tumors (CBTs), also known as paragangliomas or chemodectomas, originate from paraganglion cells at the carotid bifurcation. They are predominantly benign, with 5% being bilateral and 10% malignant. The primary treatment modality is surgical excision, though larger tumors and higher Shamblin grades pose increased operative risks. Adequate preoperative biochemical, anatomical, and radiological evsaluation is critical for successful management. Materials and Methods A retrospective analysis of eight patients treated for CBTs from January 2020 to the present was conducted. The cohort included 3 males and 5 females, aged 23 to 57 years. Detailed clinical assessments, including imaging and surgical outcomes, were reviewed. Specialized training recommendations for neurosurgeons in microvascular anastomosis and bypass procedures were emphasized to ensure optimal patient care. Results Among the eight patients, no perioperative mortality was reported. Case highlights included a 28-year-old female presenting with painless progressive neck swelling and hoarseness without vocal cord palsy or other focal neurological deficits, and a 42-year-old male with hypertension presenting with painless neck swelling and Horner’s syndrome. Effective surgical excision with preservation of the carotid artery and surrounding structures was achieved in all cases, underscoring the importance of surgical expertise and interdisciplinary training. Conclusion Surgical management of CBTs requires a multidisciplinary approach and advanced neurosurgical skills, particularly in microvascular anastomosis and bypass procedures. Subspecialized training in cerebrovascular surgery is essential to improve operative outcomes. Thorough preoperative evaluation and skillful execution are pivotal in ensuring "happy surgeries" with minimized complications

Keywords
INTRODUCTION

Carotid body tumors (CBTs), also referred to as paragangliomas or chemodectomas, are rare neuroendocrine neoplasms that arise from the paraganglion cells located at the bifurcation of the common carotid artery. These tumors are typically benign; however, a small proportion can exhibit malignant potential, with metastases reported in approximately 10% of cases (1,2). Notably, around 5% of CBTs occur bilaterally, often in the context of genetic syndromes such as hereditary paraganglioma syndromes (3).

 

CBTs are primarily vascular, receiving their blood supply from branches of the external carotid artery, particularly the ascending pharyngeal artery (4). Symptoms vary depending on tumor size and location but commonly include a painless, progressive swelling in the neck. Larger tumors may compress or invade adjacent structures, leading to symptoms such as hoarseness, cranial nerve deficits, or, in rare cases, Horner’s syndrome (5,6).

 

Surgical excision remains the definitive treatment for CBTs, with the primary aim of complete tumor removal while preserving critical neurovascular structures. However, the complexity of the procedure increases with larger tumors and higher Shamblin grades, which are associated with elevated risks of neurovascular complications (7). Advances in surgical techniques, including microvascular anastomosis and bypass procedures, are essential for improving outcomes in challenging cases (8,9).

 

This study evaluates the clinical presentation, management, and outcomes of patients with CBTs and emphasizes the need for specialized training in cerebrovascular surgical techniques to ensure optimal treatment results.

MATERIALS AND METHODS

Study Design and Participants

This retrospective study analyzed the clinical and surgical outcomes of patients diagnosed with carotid body tumors (CBTs) at a single center between January 2020 and the present. A total of eight patients were included in the study, comprising three males and five females, aged between 23 and 57 years.

 

Clinical Evaluation

All patients underwent a comprehensive preoperative evaluation, including detailed clinical history, physical examination, and imaging studies. Specific symptoms, such as painless progressive neck swelling, hoarseness of voice, and neurological deficits, were documented. Imaging modalities such as Doppler ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) were employed to confirm the diagnosis and assess tumor size, location, and involvement of adjacent structures.

 

Surgical Management

All cases were treated surgically, with the primary objective of complete tumor excision while preserving vital neurovascular structures. The Shamblin classification system was utilized to grade the tumors and assess surgical complexity. Intraoperative strategies were tailored based on tumor size and vascular involvement, with meticulous care taken to maintain carotid artery integrity.

 

Specialized Training Emphasis

To address the surgical challenges posed by CBTs, emphasis was placed on advanced neurosurgical techniques, including microvascular anastomosis and bypass procedures. Residents were trained in these specialized procedures to ensure adequate skill acquisition for complex cerebrovascular surgeries.

 

Data Collection and Analysis

Patient demographics, clinical presentations, imaging findings, surgical details, and postoperative outcomes were collected and analyzed. Specific outcomes, such as the preservation of neurovascular structures, incidence of complications, and mortality, were documented to evaluate the effectiveness of the surgical management protocol.

RESULTS

Demographics and Clinical Features

A total of eight patients diagnosed with carotid body tumors (CBTs) were included in the study. The cohort consisted of 3 males (37.5%) and 5 females (62.5%) with an age range of 23 to 57 years. The majority of patients presented with painless progressive swelling in the neck. Specific symptoms included hoarseness of voice in one patient and Horner’s syndrome in another. None of the patients exhibited vocal cord palsy or other focal neurological deficits.

 

Surgical Outcomes

All patients underwent successful surgical excision without perioperative mortality. The tumors were managed with preservation of the carotid artery and associated structures. Specialized surgical techniques, including microvascular anastomosis and bypass procedures, were highlighted as critical for ensuring optimal outcomes.

 

Summary of Findings

The detailed findings are presented in Table 1, which includes demographic data, clinical presentations, and surgical outcomes for the cohort.

 

Table 1: Summary of Patient Demographics, Clinical Features, and Outcomes

Patient No.

Age (years)

Gender

Clinical Features

Key Surgical Notes

Outcome

1

28

Female

Painless neck swelling, hoarseness

Tumor excised, carotid preserved

No mortality

2

42

Male

Painless neck swelling, Horner’s syndrome

Tumor excised, carotid preserved

No mortality

3

35

Female

Painless neck swelling

Tumor excised, carotid preserved

No mortality

4

50

Female

Painless neck swelling

Tumor excised, carotid preserved

No mortality

5

57

Male

Painless neck swelling

Tumor excised, carotid preserved

No mortality

6

23

Female

Painless neck swelling

Tumor excised, carotid preserved

No mortality

7

47

Female

Painless neck swelling

Tumor excised, carotid preserved

No mortality

8

38

Male

Painless neck swelling

Tumor excised, carotid preserved

No mortality

.

Specialized Training Needs

The study underscores the importance of advanced surgical training for neurosurgeons, particularly in microvascular anastomosis and bypass procedures, to manage CBTs effectively. This aligns with the increasing complexity of surgeries involving larger tumors and higher Shamblin grades.

DISCUSSION

Carotid body tumors (CBTs) are rare neuroendocrine tumors originating from paraganglion cells at the carotid bifurcation. Although mostly benign, a small percentage exhibit malignant behavior, with metastasis reported in up to 10% of cases (1,2). The present study highlights the clinical presentation, management strategies, and outcomes of eight patients treated for CBTs, reinforcing.

 

The majority of patients in this study presented with painless progressive neck swelling, a hallmark feature of CBTs, consistent with previous literature (3,4). Hoarseness of voice and Horner’s syndrome were observed in isolated cases, reflecting potential tumor-related compression of cranial nerves or sympathetic pathways (5). Notably, no patients exhibited vocal cord palsy or other focal neurological deficits, underscoring the variability in CBT presentation.

 

Surgical excision remains the cornerstone of CBT management, particularly for larger tumors or those classified as Shamblin II or III, which pose higher operative risks (6,7). Advances in vascular surgical techniques, including microvascular anastomosis and bypass procedures, have significantly improved outcomes in complex cases (8). In this series, all patients underwent successful tumor excision without perioperative mortality, aligning with recent studies reporting low mortality rates in specialized centers (9,10).

 

Managing CBTs involves significant challenges, particularly in preserving vital structures such as the carotid artery and cranial nerves. Larger tumors with extensive vascular involvement necessitate advanced surgical expertise, highlighting the need for specialized training in cerebrovascular surgery and microvascular anastomosis (11,12). Furthermore, preoperative planning using detailed imaging modalities, including computed tomography angiography (CTA) and magnetic resonance imaging (MRI), is essential for assessing tumor anatomy and vascularity (13).

 

The management of CBTs demands a multidisciplinary approach involving neurosurgeons, vascular surgeons, and radiologists. Referral to specialized cerebrovascular centers for advanced cases is critical for optimizing outcomes. As highlighted in the present study, collaboration between surgical teams and robust training in bypass techniques are key components of successful CBT management (14,15).

This study is limited by its small sample size and retrospective design, which may not capture the full spectrum of CBT presentation and outcomes. Larger, multicenter prospective studies are needed to validate these findings and refine management protocols.

CONCLUSION

This study underscores the importance of surgical expertise, advanced training, and a multidisciplinary approach in the management of CBTs. Emphasis on specialized techniques such as microvascular anastomosis and bypass procedures is essential for achieving favorable outcomes, particularly in challenging cases. Future research should focus on long-term outcomes and the role of genetic factors in CBT progression.

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  10. Power AH, Bower TC. Carotid body tumors: A current perspective on evaluation and management. Vasc Endovascular Surg. 2015;49(5–6):319–24.
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