Evaluating the role of embolization and carotid artery sacrifice and reconstruction in the management of carotid body tumors

OBJECTIVES/HYPOTHESIS: To review the surgical management of carotid body tumors (CBT), outcomes of carotid artery reconstruction, as well as utility of preoperative embolization. STUDY DESIGN: Retrospective chart review. METHODS: A single-surgeon case series with chart review was performed of all cases between 1997 and 2014 at a single institution. Tumor classification, major neurovascular resection, requirement for in-line carotid artery reconstruction, intraoperative blood loss, and operative time, and postoperative neurovascular complications were determined. RESULTS: In all, 96 patients with 101 CBTs underwent definitive resection disease. Vascular sacrifice was 2.9% (three) for the internal jugular vein, 8.9% (nine) for the external carotid artery, and 13.8% (14) for the internal carotid artery (ICA). ICA sacrifices were performed with immediate in-line arterial bypass grafting with vascular surgery. Permanent cranial neuropathies occurred in 4.9% (five) of patients, without cerebrovascular events. CONCLUSIONS: We recommend surgical resection as the primary approach to the management of these CBTs. In lesions involving the ICA, we recommend vein bypass grafting. We found no differences or advantages to preoperative embolization. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:2282-2287, 2016.