title: Preoperative Imaging Features are Associated with Surgical Complications Following Carotid Body Tumor Resection.
abstract: BACKGROUND
  Surgical resection remains the treatment of choice for carotid body tumors (CBTs). Although perioperative complications such as carotid artery injury and neurological deficits occur infrequently, they can be devastating. The aim of this study was to evaluate whether clinical factors or preoperative imaging findings can accurately predict perioperative complications.
  
  
  METHODS
  Twenty CBTs were resected from 19 patients. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) of the neck were used to measure the degree of circumferential involvement of the CBT to the internal carotid artery (ICA), carotid artery narrowing, tumor length, tumor volume, and the distance from the tip of the C2 dens to the superior aspect of the CBT (dens-CBT). Operative reports and Shamblin classification (I-III) of each tumor were independently reviewed. Preoperative imaging features were compared to perioperative cranial nerve injury (CNI), rates of carotid artery injury, and major carotid artery repairs, as well as Shamblin classifications≥II.
  
  
  RESULTS
  CNI was associated with a high-lying CBT (dens-CBT=1.8 vs. 2.9 cm, p<0.01). All four patients with CNI had a dens-CBT of <3 cm. Neither tumor length and tumor volume nor the involvement of the ICA (≥180° as measured by CT or MRI) was associated with CNI, carotid artery injury, major carotid artery repair, or Shamblin II or III classification. No carotid artery narrowing was observed in any of the cases.
  
  
  CONCLUSIONS
  Preoperative measurement of the dens-CBT is helpful in identifying CBTs at risk for CNI after surgical resection.
authors.affiliation: Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA, david.m.straughan@gmail.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Straughan
authors.forename: Vladimir K
authors.initials: VK
authors.lastname: Neychev
authors.forename: Samira M
authors.initials: SM
authors.lastname: Sadowski
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: Francine
authors.initials: F
authors.lastname: Thomas
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Patronas
authors.forename: Karel
authors.initials: K
authors.lastname: Pacak
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Naris
authors.initials: N
authors.lastname: Nilubol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020212:Carotid Artery Injuries / Q000453:epidemiology*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology; D002345:Carotid Body Tumor / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D020209:Cranial Nerve Injuries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult
references.citation: J Vasc Surg. 2010 Dec;52(6):1518-23
references.pmid: 21146747
references.citation: Oral Oncol. 2005 Jan;41(1):56-61
references.pmid: 15598586
references.citation: Laryngoscope. 1984 Aug;94(8):1008-15
references.pmid: 6087052
references.citation: Am J Surg. 2014 Feb;207(2):293-8
references.pmid: 24119888
references.citation: Otolaryngol Head Neck Surg. 1997 Jul;117(1):111-5
references.pmid: 9230333
references.citation: Ann Surg. 2014 Jul;260(1):158-62
references.pmid: 24169168
references.citation: J Clin Endocrinol Metab. 2001 Nov;86(11):5210-6
references.pmid: 11701678
references.citation: Laryngoscope. 1995 Mar;105(3 Pt 1):231-5
references.pmid: 7877408
references.citation: J Geriatr Cardiol. 2013 Mar;10(1):116-8
references.pmid: 23610583
references.citation: Vasc Endovascular Surg. 2002 Jul-Aug;36(4):277-83
references.pmid: 15599478
references.citation: Head Neck. 1998 Aug;20(5):374-8
references.pmid: 9663663
references.citation: AJNR Am J Neuroradiol. 2008 Aug;29(7):1349-54
references.pmid: 18417602
references.citation: Am J Surg. 2006 Jan;191(1):104-10
references.pmid: 16399116
references.citation: Eur Arch Otorhinolaryngol. 2006 Feb;263(2):171-5
references.pmid: 16010570
references.citation: Oral Oncol. 2004 Jul;40(6):563-75
references.pmid: 15063383
references.citation: Am J Surg. 1971 Dec;122(6):732-9
references.pmid: 5127724
references.citation: Am J Surg. 1981 Sep;142(3):362-5
references.pmid: 7283029