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Large Symptomatic Carotid Body Tumor Resection Aided by Preoperative Embolization and Mandibular Subluxation

Konstantinos T. Delis, MD, PhD

Charles E. Fields, MD

Department of Surgery, Division of Vascular Surgery, Mayo Clinic

Christopher F. Viozzi, MD

Department Oral and Maxillofacial Surgery, Mayo Clinic

David F. Kallmes, MD

Department of Radiology, Mayo Clinic

Peter Gloviczki, MD

Department of Surgery, Division of Vascular Surgery, Mayo Clinic; Gonda Vascular Center, 200 First Street SW Rochester, MN 55905 gloviczki.peter{at}mayo.edu

Carotid body tumors (CBT) are rare and usually benign neoplasms (60%-90%), originating from the mesoderm and neural ectoderm. In view of the extensive and unrelenting growth of unresected CBT, encasing vital neurovascular structures, and the significant incidence of malignancy (>10%), surgical excision is the standard treatment of choice. Despite progress in CBT imaging and surgical technique, cranial nerve deficit, stroke, and death continue to affect 10% to 40% of patients undergoing curative surgical resection, particularly in large tumors proximal to the skull base. In such cases, CBT shrinkage by preoperative embolization, improved surgical access utilizing mandibular subluxation, and electroencephalographic monitoring combined with meticulous surgical technique may enable curative tumor resection, without prohibitive morbidity. In light of associated disability, preoperative acknowledgment of the ever-present substantial risk of cranial nerve injury cannot be overemphasized. We report on a patient with a large symptomatic CBT treated surgically with the aid of mandibular subluxation and preoperative embolization.

Key Words: carotid body tumors • mandibular subluxation • embolization

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 17, No. 1, 21-28 (2005)
DOI: 10.1177/153100350501700106


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