Baroreflex Failure After Surgical Resection of Bilateral Carotid Body Tumors: A Systematic Review

Objective Surgery remains the definitive treatment for carotid body tumors (CBTs); however, concern persists regarding the risk of baroreflex failure (BRF) following bilateral CBT resection. The true incidence and long‐term clinical course of BRF remain poorly defined. We performed a systematic review to examine the risk and clinical course of BRF after surgical resection of bilateral CBTs. Data Sources PubMed/Medline, Scopus, and Cochrane. Review Methods A systematic review was performed based on a population, intervention, comparison, and outcome search (PICOTS) of reports on BRF in surgical resection of bilateral CBTs. Additional articles were added by citation searching. The study was reported per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results This systematic review included 15 single case reports and 8 case series of BRF in surgical resection of bilateral CBTs. No higher quality studies of clinical trials or cohort studies were available. Results from this systematic review showed that BRF symptoms most commonly occurred immediately after the second surgery in bilateral CBT resections, and that many reported cases demonstrated improvement over time, although long‐term outcomes were inconsistently reported. Commonly used treatments of BRF included clonidine and benzodiazepines. Conclusion Despite the commonly perceived high risk and debilitating clinical outcomes, the reported clinical course of BRF following bilateral CBT resection appears more variable and, in many cases, less severe than historically perceived. The optimal management of CBTs remains unclear, though surgical resection of bilateral CBTs warrants individualized consideration based on age, tumor characteristics, genetic risk, and treatment goals. Level of Evidence 3.