Resection of carotid body tumors: results of an evolving surgical technique

Objective: To evaluate a modified technique for carotid body tumor (CBT) resection. Background: Resection of CBT can lead to substantial postoperative morbidity because of a rich vascularization and close connection to neurovascular structures. The impact of a modified surgical technique on postoperative outcome was evaluated and compared with a historical group and the literature. Methods: Medical records of patients who underwent CBT surgery at Leiden University Medical Center between 1963 and 2005 were retrospectively reviewed. Before 1992, a standard approach was conducted. After 1992, most tumors were resected using an alternative technique, working in a craniocaudal fashion from skull base to carotid bifurcation. Data were reported as details of the pre, intra-, and postoperative periods. Results: A total of 111 CBT resections (69 standard, 42 craniocaudal) were performed in 94 patients (44 male/50 female, mean age 41). The standard group consisted of 39 Shamblin I (56%), 22 II (32%), and 8 III (12%) tumors. The craniocaudally approached CBT included 12 Shamblin I (29%), 13 II (31%), and 17 III (40%) tumors. The mean blood loss was 901 mL (standard operations) versus 281 mL (craniocaudal approach, P 0.0005). Persistent cranial nerve damage was encountered after 26 (23%) of 111 operations; 21 after the standard operations (30% within this group, including 3 preexistent nonresolved cranial nerve deficits); and 5 (12%, including 2 due to additional vagal body resections) after the craniocaudal operations (P 0.025). Conclusions: The craniocaudal dissection technique of a CBT can be applied with little blood loss, thereby reducing the risk of postoperative morbidity. arotid body tumors (CBT) are neoplasms arising from paraganglionic tissue at the bifurcation of the common carotid artery. The aim of the surgical management is the complete removal of CBT at an early stage to prevent further growth with the risk of local involvement of adjacent neurovascular structures. Resection of the CBT at an early stage reduces the chance of intraoperative blood loss and surgeryinduced morbidity. Control of the internal and external carotid arteries and the smaller supplying vessels is imperative to facilitate a dry operation field. The dissection along the relatively avascular plane should furthermore result in pres