Management of large carotid body tumor: Case report

Abstract

Introduction. Carotid body tumors (CBT) are slow-growing hypervascular tumors arising from paraganglionic cells of the carotid body. Although the most common form of head and neck paraganglioma, CBT remain rare, with a reported incidence of 0.06 to 3.33 per 100 000 patients. CBT are usually benign. Surgery for young and healthy patients is the first choice of treatment. We present a case of unilateral benign CBT (Shamblin type III) in a 52-year-old male after one-year follow-up. Case Report. A 52-year-old male with 5 years history of slow-growing, asymptomatic, right lateral neck mass. Ultrasonography (US) demonstrated cervical mass beyond the angle of mandible. MRI combined with CT scanning showed large (62x54x41mm) highly vascularized soft-tissue mass completely surrounding the right carotid bifurcation, with compressive effect to larynx and internal jugular vein. Patients underwent surgery under general anesthesia by a multidisciplinary team. During procedure Near-infrared spectroscopy monitoring of the continuous regional oxygen saturation (rSO2) was measured with a cerebral oximeter (Somanetics Invos cerebral oximeter). Through a transverse cervical incision all neurovascular structures were identified and periadventitial. Proximal and distal control established, ECA was ligated and dissected, ICA and CCA cross clamped. Complete and safe tumor resection achieved. CCA to ICA was reconstructed by a termino-terminal anastomosis using ePTFE 6/4 vascular graft. Postoperatively, a transient swallowing difficulties and ipsilateral tongue deviation developed. Concusion. Larger CBT need a multidisciplinary centralized approach as the best choice, including combined competent vascular, maxillofacial, radiology and otolaryngology team.