Surgical treatment of carotid body paragangliomas: outcomes and complications according to the shamblin classification

Abstract

Objectives: The objective of this study was to review our experience in the surgical management of carotid body paragangliomas and evaluate the outcomes and complications according to the Shamblin classification.

Methods: Thirteen patients who had been diagnosed and surgically treated for carotid body tumors (CBTs) were enrolled in this study. We reviewed patient demographics, radiographic findings, and surgical outcomes collected from medical records.

Results: Fifteen CBTs were found in 13 patients and 13 tumors were resected. Selective preoperative tumor embolization was performed on six patients. The median blood loss, operation time, and hospital stay for these patients were not significantly reduced compared to those without embolization. The median tumor size was 2.3 cm in Shamblin I and II and 4 cm in Shamblin III. The median intraoperative blood loss was 280 mL and 700 mL, respectively (P<0.05). Internal carotid artery ligation with reconstruction was accomplished on three patients (23%), and they all belonged to Shamblin III (38%). One Shamblin III patient (8%) developed transient cerebral ischemia, and postoperative stroke with death occurred in another Shamblin III patient. Postoperative permanent cranial nerve deficit occurred in three patients (23%) who were all in Shamblin III (P=0.03). There were no recurrences or delayed complications at the median follow up of 29 months.

Conclusion: Shamblin III had a high risk of postoperative neurovascular complications. Therefore, early detection and prompt surgical resection of CBTs will decrease surgical morbidity.

Keywords: Carotid body tumor; Paraganglioma.

Fig. 1

A 35-yr-old woman with a characteristic carotid body paraganglioma. (A) Axial contrast-enhanced CT shows an avidly enhancing mass splaying the external carotid artery (ECA) and internal carotid artery (ICA) at the left carotid bifurcation. (B) Axial T1- weighted images show a mass with prominent vascular flow voids. (C) Angiography shows intense tumor blush between the ICA and ECA.