Adventitial dissection with advanced vessel-sealing for carotid body paraganglioma: A 2-year recurrence-free case...

Carotid body paragangliomas present unique surgical challenges due to their hypervascular nature and proximity to critical neurovascular structures. Subadventitial dissection combined with vessel-sealing techniques represents a technical option to achieve complete resection while minimizing complications, though long-term outcome reports remain limited.

A 52-year-old male presented with a 2-month history of a pulsatile left cervical mass associated with chronic neck pain. Examination revealed classic clinical signs (Kocher's and Fontaine's positive). Imaging demonstrated a 3.5 cm Shamblin I tumor at the carotid bifurcation with with <180° arterial contact (Arya I) and preserved vascular anatomy. Biochemical testing confirmed a non-secreting profile. The patient underwent en bloc resection via subadventitial dissection and vessel-sealing, achieving complete tumor removal without vascular reconstruction or nerve injury.

This case highlights several key technical considerations in carotid body tumor management. The subadventitial plane provides a dissection barrier, facilitating hemostasis and vascular preservation. Vessel-sealing devices may complement traditional techniques for vascular control. The 2-year recurrence-free outcome supports this approach for selected tumors, though longer follow-up is needed. Cranial nerve preservation highlights the importance of meticulous dissection.

Subadventitial dissection with vessel-sealing can achieve favorable outcomes in Shamblin I carotid body paragangliomas, enabling complete resection with neurovascular preservation. Further evaluation in larger cohorts is warranted.