Carotid Body Tumor with Skull Base Extension

Area of Science:

• Neuro-oncology
• Vascular surgery
• Head and neck surgery

Background:

• Carotid body tumors (paragangliomas) are rare neoplasms originating from paraganglionic cells of the carotid body.
• Surgical resection is the primary treatment for these typically benign tumors.

Observation:

• A 59-year-old male presented with a massive benign left carotid body tumor.
• The tumor encased ipsilateral carotid vessels and cranial nerves (vagus, hypoglossal), compromised the airway, and extended to contralateral carotid vessels and the skull base.
• Preoperative endovascular coiling of carotid vessels was necessitated by the tumor's cranial extension.

Findings:

• Massive carotid body tumors present significant surgical and neurovascular challenges.
• Endovascular coiling of the internal carotid artery above the skull base is a viable approach for managing large parapharyngeal tumors with cranial extension.
• The case suggests the need for a Shamblin IV classification to include tumors with skull base extension requiring preoperative endovascular intervention.

Implications:

• This case underscores the importance of advanced endovascular techniques in managing complex head and neck tumors.
• A revised Shamblin classification could improve surgical planning and risk stratification for carotid body tumors.
• Further research into multidisciplinary management strategies for extensive carotid body tumors is warranted.