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Published on: October 20, 2017
Management of Shamblin Type III Carotid Body Tumor With Preoperative Embolization, Surgical Resection, and Rescue
Michal S Proczka1, Piotr Kaszczewski1, Michał M Sajdek2
1Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.
Insights
Carotid body tumors (CBTs) pose significant surgical challenges. This case highlights the successful management of a complex CBT with preoperative embolization and surgical repair, despite complications like stroke.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Endovascular Therapy
Background:
- A 51-year-old woman presented with a large Shamblin type III carotid body tumor (CBT) encasing the carotid artery.
- The patient had a history of transient ischemic attack (TIA), indicating potential cerebrovascular compromise.
Purpose of the Study:
- To describe the management of a complex carotid body tumor (CBT) encasing the carotid artery.
- To highlight the challenges and outcomes of surgical resection and endovascular intervention for CBTs.
Main Methods:
- Preoperative embolization of the carotid body tumor (CBT).
- Surgical resection of the CBT with common carotid artery repair and temporary shunting.
- Postoperative endovascular intervention including stent implantation and mechanical thrombectomy for identified thrombus.
Main Results:
- The surgical excision was complicated by intraoperative bleeding and damage to the common carotid artery.
- Postoperative stroke occurred, necessitating endovascular intervention.
- The patient experienced transient neurological deficits which resolved completely after rehabilitation.
Conclusions:
- Carotid body tumors (CBTs) present complex therapeutic challenges despite their low incidence.
- An interdisciplinary approach involving multiple surgical and endovascular specialties is crucial for successful management of complex CBTs.
Abstract:
BACKGROUND This report describes the case of a 51-year-old woman with a history of transient ischemic attack and a diagnosis of a large Shamblin type III carotid body tumor (CBT) encasing the carotid artery. The CBT was managed by preoperative embolization and surgical resection, which was complicated by postoperative stroke and arterial damage requiring surgical repair. CBTs are usually slow-growing, pulsatile cervical tumors that can cause clinical symptoms secondary to catecholamine secretion in functional lesions or symptoms related to compression of adjacent structures in nonfunctional lesions. CASE REPORT The patient was diagnosed with CBT. Ten months prior, she had a transient ischemic attack with left-sided temporary hemiparesis. The surgical excision of the CBT was preceded by endovascular embolization. Despite this, significant bleeding occurred intraoperatively. The complete excision of the CBT was complicated by damage of the common carotid artery, with repair requiring temporal shunting. Two hours after surgery, the patient showed weakness of the left side of the body. Dissection of the right common and internal carotid arteries, occlusion of the external carotid artery, and a thrombus at the bifurcation of the right middle cerebral artery were identified on computed tomography. A successful endovascular intervention with stent implantation and mechanical thrombectomy was performed. Postoperatively, a slight face asymmetry and mild deterioration of upper limb mobility were observed, which resolved completely following successful rehabilitation. CONCLUSIONS Despite having a low incidence, CBTs remain a serious therapeutic problem. An interdisciplinary approach and availability of different specialties is key to successful treatment of complex CBTs.