• Vascular Specialist Newspaper
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CHICAGO -- Surgical resection remains the treatment of choice for carotid body tumors, as presented in a review of 88 patients at a single center.

Radiation therapy and chemotherapy are unsuitable because these rare tumors are too slow growing, and radiation exposes the carotid arteries to radiation arteritis, accelerated atherosclerosis, and even necrosis, Dr. Thomas A. Whitehill said at a vascular surgery symposium sponsored by Northwestern University.

Preoperative percutaneous tumor embolization has been tried with mixed results, but can be an important adjunct when treating select patients with large tumors (greater than 6 cm). There has been one report of a successful use of covered stents to facilitate resection (J. Vasc. Surg. 2003;38:389-91).

The malignancy rate for carotid body tumors is hard to define because there are no reliable histologic markers, but is thought to range from 2% to 5%, he said. Even if benign on histologic exam, all tumors, once discovered, should be surgically removed because they will ultimately wrap around the internal and external carotid arteries, erode into the base of the skull, and entrap neighboring cranial nerves. Increasing size also can interfere with speech, swallowing, and respiration, said Dr. Whitehill, vascular surgery division of University of Colorado Health Science Center, Denver.

From 1993 to 2007, Dr. Whitehill and colleagues surgically resected 88 Shamblin classification II or III carotid body tumors, with an average diameter of 10.4 cm (range 5-16 cm). The patients ranged in age from 30 to 40 years. Surgery time ranged from 4 to 14 hours, with an average blood loss of 375 mL (range 50-1800 mL). An internal carotid artery (ICA) resection bypass was performed in three patients, and ICA ligation in none.

Complications were relative low, Dr. Whitehill said, and included cranial nerve IX neuropraxia (4%) or injury (1%), cranial nerve XII neuropraxia (30%), and superior laryngeal nerve injury (10%). There were no strokes or deaths.