Koen E. van der Bogt, Maarten Paridaans, Emile Nyns, Jary M. van Baalen, Hajo van Bockel, Jaap F. Hamming
Leiden University Medical Center, Leiden, Netherlands.
OBJECTIVES: To present and evaluate a novel technique for carotid body tumor (CBT) surgery.
METHODS: The craniocaudal dissection technique is based upon early identification of the vagal, hypoglossal and facial nerves, control of the internal carotid artery, and ligation of the ascending pharyngeal artery, all at the CBT's cranial side. Thereafter, with optimal control over neurovascular structures, dissection is carried out in a cranial to caudal fashion. A retrospective analysis of all craniocaudally operated CBT patients in the past 20 years was carried out and results were compared to the current literature describing results from the conventional (caudal to cranial) operative technique.
RESULTS: Ninety CBTs were removed in 77 patients (53% female, mean age 41 years). There were 20 Shamblin I, 36 Shamblin II and 34 Shamblin III CBT. Sixty-five percent of patients had positive family history and 66% of tumors were part of bilateral CBT. Mean operative blood loss was 227±260mL and postoperative temporary nerve palsy was 20%, which was related to increasing Shamblin classification (p=0.03). Only four patients (4.4%, n=3 Shamblin III, p=NS) suffered from permanent cranial nerve palsy, and one (1.1%) patient experienced a stroke postoperatively. These per- and post-operative results compare favorable to the complication rates reported in contemporary literature (commonly>10% persistent cranial nerve palsy).
CONCLUSIONS: This large series of surgically treated CBTs strongly supports a craniocaudal dissection as surgical technique of choice as it limits blood loss and facilitates safe CBT dissection with a low complication rate.
AUTHOR DISCLOSURES: J. F. Hamming: Nothing to disclose; E. Nyns: Nothing to disclose; M. Paridaans: Nothing to disclose; J. M. van Baalen: Nothing to disclose; H. van Bockel: Nothing to disclose; K. E. van der Bogt: Nothing to disclose.
Posted April 2013