Management for carotid body paragangliomas

The carotid body tumor is a rare neoplasm that has generated much literature over the last century, and for which continued controversy exists regarding natural history, biologic behavior, proper technique of excision, and the risk of morbidity and mortality. The present study reviewed a 16-year experience of managing carotid body paraganglioma (CBP) between 1988 and 2004. There were 10 consecutive patients aged between 18-42 years with tumors and median follow-up was 10 years. Preoperative information was derived from spiral CT scanning, magnetic resonance imaging (MRI), color Doppler imaging (CDI), and four-vessel digital subtraction arteriography. In five patients the tumor excision was attempted before they were referred to our tertiary care hospital. Two patients had bilateral tumors. Four patients had preoperative embolization, and blood loss was minimal, and excision was relatively easier in them. There was difficulty in deglutition (nasal and laryngeal regurgitation) in three patients with large tumors and who required nasogastric tube feeding (1 to 3 weeks). Surgical planning and prediction of peri-operative complications can be obtained by digital subtraction angiography, spiral CT angiography and color Doppler imaging. The peri-operative blood loss can be reduced by preoperative embolization.