Carotid Body Tumor
Carotid body tumors, also known as called chemodectomas or paragangliomas, are benign tumors of the neck. Carotid body tumors originate from specialized sensors, called the Carotid body, on the lining of the Carotid arteries, the blood vessels that supply blood the head and brain (Fig. 1 Carotid Arteries). Carotid body tumors are found in three scenarios, sporadic, inherited, and acquired. 85% of the time, Carotid body tumors occur randomly. 10‐50% of the time, Carotid body tumors can be inherited, and the remainder of the time they can be caused by chronic lack of oxygen. This occurs in patients that live at high altitude or have disease causing low blood oxygen such as chronic obstructive pulmonary disorder. Carotid body tumors occur in 1‐2 out of 100,000 people and most commonly occur in middle‐aged people, around 45 years old. Other paragangliomas can be found in the area surrounding the Carotid artery including the jugular vein and vagus nerve. 97% of the time the tumors are benign (they do not spread). They need to be treated because they will continue to grow and damage surrounding structures including nerves and other blood vessels.
Symptoms & Diagnosis
The most common symptom of Carotid body tumors is a slowly growing painless pulsa%le mass in the side of the neck (Fig. 2 Carotid body tumors). These tumors typically grow very slowly, doubling approximately every 7 years. Approximately 10%, Carotid body tumors may impinge on surrounding nerves causing hoarseness, pain, shoulder weakness, difficulty swallowing, change of vision, and a drooping lid. Sometimes Carotid body tumors secrete hormones causing flushing, heart palpitations, high blood pressure, and/or sweating.
Fig. 3Carotid bifurcation spreading
Fig. 4 Carotid bifurcation spreading
Fig. 5 Carotid bifurcation spreading
Diagnosis of Carotid body tumors is made with a combination of history and physical examination taken by the doctor used in combination with advanced radiological imaging. Depending on the situation, a CAT scan or MRI may be used in addition to aid in the diagnosis (Fig. 3 & 4); on these exams the mass can be seen at the crotch of the Carotid bifurcation spreading the internal and external Carotid arteries (This is called the Lyre Sign). CT Angiogram also helps clearly outline the tumor and the blood vessels that feed it (Fig. 5).
Carotid body tumors may be treated with either surgery or radiation treatment. The treatment plan depends on the size of the tumor, involved structures (Fig. 6a), the age of the patient, health of the patient, number of tumors, and patient preference. In general, young healthy patients with small tumors are good candidates for surgery. patients in poor health or with large tumors are poorer surgical candidates and may choose to undergo radiation. Ofen before surgery angiography and embolization of the vessels feeding the tumor is done; this will not only decrease blood loss during surgery but also cause a the tumor to shrink a little, making the surgery easier and safer.
|Fig. 7 Neck Nerve||Fig. 8 Incision|
Surgery by the surgoens at the Center typically takes between 2‐5 hours depending on the size of the tumor. If the tumor is large, sometimes the Carotid artery has to be removed and reconstructed with graft or a bypass (exceedingly rare). patients are in the hospital for 1‐3 days and have excellent outcome. Our patient’s are able to eat and walk immediately after surgery (Fig. 7, 8, 9 Incision Opened, & 10 Carotid Body Tumor Removed).