[Glomus tumors: a diagnostic and surgical challenge?]

Abstract

Within a population of 1150 vascular patients over a time period of 10 years we saw a carotid body tumor (synonymous chemodectoma) in only 11 cases. A correct preoperative diagnosis was found only in three patients. Before being treated by a specially trained team of vascular surgeons, eight patients had undergone inadequate operations. These were performed with a high incident of local complications. Simple bedside physical examination of the patient while looking for the signs of Fontaine and Kocher I + II (20) assures the diagnosis. Confirmation can be achieved by color-flow Doppler sonography (2). For the surgical resection, the only therapeutic alternative to the "gold standard" is angiography in digital subtraction technique which illustrates the blood supply of the tumor (70% exclusively by the external carotid artery). Also, it shows the typical intercarotid widening and the rich vascular conglomerate in between. Malignancy was detected in one case only (pulmonary metastasis). In two cases concomitant tumors of the jugular vein were seen. The interruption of the blood flow in the external carotid artery facilitates the surgical approach substantially. The ligature of this vessel (six patients) and the interposition of saphenous vein grafts (all 11 cases) for reconstruction of the internal carotid vessel were employed as the surgical strategy. Even the exstirpation of a large tumor (18 x 11 x 9 cm) extending from the skull base and almost reaching the left clavicular bone was successfully performed.(ABSTRACT TRUNCATED AT 250 WORDS)