Neurological Complications in Surgical Management of Carotid Body Paragangliomas

Abstract

Introduction: Carotid body tumors are rare neoplasm and must be considered in the evaluation of all lateral neck masses. Though surgical excision of carotid body tumor is a challenge to the surgeon, early surgical excision is considered. Cranial nerve injuries are common because of its proximity to the carotid body tumor.

Methods: Fifteen carotid body tumors operated on 14 patients over ten year period from July 2003 to June 2013 were retrospectively reviewed. Six (42.9%) of the patients were male and eight (57.1%) were female. The average age was 41.9 years (23 to 70 years). Physical examination, radiological evaluation, method of treatment and postoperative complications were studied. Four cases belonged to Shamblin class II and 11 to Shamblin class III. Six (40%) cases were operated with carotid shunt and four (26.7%) with clamping of carotid artery. Division of external carotid artery was required in five (33.3%) cases. Polytetrafluoroethylene  graft was used to maintain continuity of internal carotid artery in three (20%) cases and external carotid artery was transposed to internal carotid artery in one (6.7%) case.

Results: Complete resection was possible in all cases. Cranial nerve palsies were noted in five (33.3%) cases. Two of them had complete recovery whereas three (20%) had permanent palsy. No stroke and mortality occurred.

Conclusion: Carotid body tumor has higher risk of cranial nerve paresis which requires good surgical skills to ensure complete removal. Vascular excision with continuity to internal carotid artery may be required while undertaking complete carotid body tumor excision.