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.
van der Bogt
Koen E A
KE
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Vrancken Peeters
Mark-Paul F M
MP
van Baalen
Jary M
JM
Hamming
Jaap F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002345:Carotid Body Tumor / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D020209:Cranial Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures