Carotid body tumors review of 56 cases

1. Carotid Body Tumors:
Review of 56 cases
Amr Gad,MD
Prof. of Vascular Surgery
Cairo University

2. Carotid Body Tumors
 Arise from paraganglionic cells derived
from the neural crest
 >50% of neck paragangliomas (PGLs)
 Incidence less than 1 in 30 000

3. Disastrous History…
1743 Von
Haller
first described the carotid body
1880 Reigner attempted excision, but the patient died.
1886 Maydl attempted excision but the patient
developed a stroke.
1889 Albert first successful CBT excision
1891 Marchand first description of the histologic
appearance
1903 Scudder first successful resection in USA
1903 Kohn first introduced the term paraganglioma
(PGL)
Till 1950s mortality and morbidity remained very high

4. Patients
54
Patients
( 25 y )
2
Bilateral
56
CBTs
56 CBTs
39 (69.64%)
In males
17 (30.36%)
In females
Age 42 y
range( 32 : 47)

5. Patients
54
Patients
(25 y )
2
Bilateral
56
CBTs
GROUP A
35(62.5%)
CORRECT
DIAGNOSIS
56 CBTs
GROUP B
21(37.5%)
MISS
DIAGNOSIS
(Prior trial of
excision)

6. Radiologic
Imaging

9. Shamblin’s Classification
(1971)
I=27 (48.21%) II=22 (39.29%) III=7 (12.5%)

10. Suggested Modification by Luna-Ortiz et al
Eur Arch Otorhinolaryngol (2006) 263: 171–175

12. Dissection Technique
(Periadventitial Plane)

13. Vascular Reconstruction was
Inevitable in 10 cases(17.85%)
54
Patients
2 bilateral
56
CBTs
56 CBTs
46 Resection
10
Resection +VR
Vein interposition graft 7
End to end anastomosis 1
lateral sutures 2

14. Vascular Reconstruction was Inevitable
in 17.85% of our cases
 This emphasizes the need for vascular experience among
the operating team.
 A multicenter review of CBTs reported that 80% of cases
were operated on by vascular surgeons.
Sajid et al, Eur J Vasc Endovasc Surg 34, 127-130 (2007)
 It was obvious that vascular reconstruction is
significantly higher among patients with prior removal
attempts (9/21 vs. 1/35, p<0.05), reflecting the
difficulties that may be encountered when operating on a
CBT that was not correctly identified from the beginning.

15. n=10
Vascular Reconstruction was
Inevitable in 17.85% of our cases

16. Vascular Reconstruction was
Inevitable in 17.85% of our cases

17. Complication Number (%)
Cerebrovascular stroke (transient
hemiparesis) 2 (3.57%)
TIA 2 ( 3.57%)
Hypoglossal nerve injury 6 (10.71%)
Superior laryngeal nerve injury 1 (1.78%)
Hematoma 1 (1.78%)
Total 12 (21.43%)
Postoperative Complications
Permanent 3.57%

18. Study name & year Number of
operated CBTs
CNI %* Vascular
reconstruction %
CVA%
Total Permanent
Studies between 1980-2000
Rosen et al (1981)15 29 28 NA NA NA
Lees et al (1981)16 41 NA 18 NA NA
Dickinson et al (1986)17 37 19 NA NA 4
Gaylis et al (1987)18 52 7 NA 13 2
Hallett et al (1988)13 139 30-46† NA 33 3-23†
Williams et al (1992)19 33 13 3 NA 27‡
Netterville et al (1995)20 46 13 NA 26 0
Muhm et al (1997)21 28 32 NA 36 NA
Rodriguez-Cuevas et al (1998)22 80 20 NA NA 4
Westerband et al (1998)23 31 13 NA 25 6
Wang et al (2000)24 36 41 24 NA 0
Studies between 2000-2010
Makeieff et al (2008)10 57 42 14 28 14‡
Sajid et al (2007)8 95 19 1 NA 1
Qin et al (2009)25 33 53 NA 30 NA
Plukker et al (2001)26 45 11 7 13 10
Papaspyro et al (2009)27 40 NA§ NA§ 25 0
van der Bogt et al (2008)12 111 21-42† 7-26† 2-4† 0
Patetsios et al (2002)28 34 46 17 28 0
Luna-Ortiz et al (2005)1 69 49 38 6 4
Dardik et al (2002)29 27 33 NA 41 4
Ma et al (2009)2 55 27 6 11 4
Kakkos et al (2009)14 41 32 10 18 7
Koskas et al (2009)30 39 NA§ 15 22 3
Ünlü et al (2009)31 28 3 NA 29 0
Paris et al (2006)32 29 NA§ NA§ 14 0

19. Preoperative Embolization
Attractive Option Prior to Surgery to Reduce Bleeding
and Tumor Bulk.
 Against:
o Associated with an inflammatory response that makes precise
periadventitial dissection more difficult .
Netterville et al Laryngoscope 1995;105(2):115-26
o A risk of intracranial embolization
Makeieff et al, Annals of Surgical Oncology 2008 ;15(8):2180-2186
o It did not affect the probability of need for vascular repair
Smith et al Ann Vasc Surg 2006;20:435-9
o Can be quite tedious and hazardous.

20. Currently, recommended only for:
o Tumors that are large (5cm in size)
o Shamblin’s class III
o Extend significantly cranially
Kakkos et al, J Vasc Surg 2009;49:1365-73
Preoperative Embolization

21. Covered Stent Placement of
ECA Scanlon et al, J Vasc Surg 2008;48:1322-4

22. Radiotherapy
 Radiosensitive but “total resolution” of the tumors
is rare.
 Local control means stability (or regression)
Possible indications:
 Minimal residual tumors
 Tumor destaging.
 Non-resectable tumors

23. Rodrı´guez-Cuevas et al, Head Neck,(1998) 20: 374–378
Luna-Ortiz et al, Oral Oncology (2005) 41, 56–61
 Our patients’ showed characteristics similar to Latin
American series as:
● Lower incidence of malignancy (4%vs.>10%)
● Lower incidence of bilaterality (9%vs.>10%)
● Lower incidence of familial cases (0%)
 This could reflect a potential genetic pattern which needs
to be further investigated.

24. Conclusion
 CBTs should be resected by surgeons with
experience in carotid reconstruction.
 Correct preoperative diagnosis and planning
for treatment are essential to avoid
complicated surgical procedures.
 CNI continue to appear in all studies in spite
of the advances in the management and
techniques, but they present minor morbidity.

25. Cairo University
School of Medicine
Thank You