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A multicenter review of carotid body tumour management
M S Sajid1, G Hamilton, D M Baker
1Vascular Unit, Department of Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.
Insights
Carotid body tumours (CBTs) are rare head and neck paragangliomas. Surgical resection offers the best treatment but carries significant risks, including a 35% morbidity rate and 1% mortality.
Area of Science:
- Head and Neck Surgery
- Vascular Surgery
- Endocrinology
Background:
- Carotid body tumours (CBTs) represent the most common type of head and neck paraganglioma (PGL).
- This study presents the largest series of CBTs in the UK/EU, addressing diagnostic and surgical challenges.
Purpose of the Study:
- To analyze diagnostic methods for carotid body tumours.
- To evaluate surgical treatment outcomes and complications.
- To report on the incidence of morbidity and mortality associated with CBT surgery.
Main Methods:
- Data from 95 patients diagnosed with CBT between 1979 and 2005 were collected via a detailed proforma sent to Joint Vascular Research Group members.
- Literature review using generic terms for carotid body tumours and paragangliomas was conducted.
Main Results:
- The mean age of presentation was 55 years, with a higher incidence in females and a predilection for the right side (58%).
- Neck lumps and pressure symptoms were common; 18% of tumours were familial, and only 4.2% were malignant.
- Surgery is the primary treatment, with a 35% morbidity rate (including 19% cranial nerve deficits) and 1% mortality. Recurrence was 4.2%.
Conclusions:
- Carotid body tumours necessitate surgical excision by experienced vascular surgeons.
- Surgical resection is linked to substantial morbidity (35%) and mortality (1%).
- While predominantly benign, malignant forms of CBT are not rare.
Objective:
Carotid body tumour (CBT) is a rare but the most common form of head and neck paraganglioma (PGL). We present the biggest ever series on CBT in UK/EU discussing diagnostic challenges, surgical treatment and complications of surgical intervention.
Method:
A detailed proforma was designed and sent to all members of Joint Vascular Research Group (JVRG). Data of 95 patients was collected. Generic terms including carotid body tumour/s, or paraganglioma/s were used to search a variety of electronic database in order to get latest informations available in literature.
Results:
A total of 95 patients were recorded in our data from 1979 to 2005. Mean age of presentation was 55 years. Incidence was higher in females. CBT was more common on right side (58%). 18% tumours were bilateral. Neck lump (98%) and pressure symptoms including cranial nerve deficits and pain were main presenting complaints. About 18% of tumours were familial. Only 4.2% were malignant. Duplex scan is the best investigation for diagnosis, though MRI, DSA and CT scan are important for preoperative assessment. Surgery is the treatment of choice. Stroke and cranial nerve injury constitute postoperative morbidity (35%) and mortality (1%). Incidence of postoperative cranial nerve deficit was about 19%. Combined ipsilateral and contralateral recurrence rate was 4.2%.
Conclusion:
CBT is a rare condition which needs surgical excision by experienced vascular surgeon. Surgical resection is associated with significant morbidity of 35% and mortality of 1%. Mostly CBT is benign but malignant forms are not uncommon.
