What is a carotid body tumor (also called chemodectomas, paraganglioma)?
Two carotid arteries (one on each side of the neck) supply blood to the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside. A carotid body tumor (also called a chemodectoma or paraganglioma) is a tumor found in the upper neck at the branching of the carotid artery.
How are carotid body tumors treated?
Although these types are not normally deadly, they can be locally aggressive; therefore, many times, removal of the tumor is recommended. Sometimes this is accompanied by radiation therapy.
What surgical treatments are available for carotid body tumors?
At Cleveland Clinic, vascular surgeons work closely with surgeons in otolaryngology (ear, nose and throat) for the multidisciplinary treatment of carotid body tumors.
Vascular surgeons generally perform the transcatheter embolization (see below description) and bypass graft, as appropriate. Your health care provider will recommend the treatment option that is right for you. Before choosing any treatment, it is important to discuss the potential benefits, risks and side effects with your health care provider. You will receive specific guidelines to help you prepare for your procedure, as well as specific instructions to help your recovery.
Two or three days prior to surgical resection of the tumor, your physician may try to stop or reduce the blood supply to the tumor by injecting medication into the area using a procedure called transcatheter embolization. Initially, your surgeon will inject a dye to define the feeding arteries and draining veins that feed the tumor. Once these are identified, they can be occluded with such embolic materials as foam, plastic particles, metal coils, ethanol or glue.
In the majority of patients (60 to 70 percent), resection of the tumor can be accomplished without concomitant repair or resection of the carotid artery. In approximately 10 percent of cases, a simple suture repair of the carotid artery is required.
More complicated carotid artery repair may be necessary in up to 25 percent of patients. The type of repair depends on the type of defect created by resecting the tumor, and may include “patching” of a hole created by tumor resection, or replacing a segment of the carotid artery with a bypass graft. In situations of more complex repairs, a temporary shunt is placed in the carotid artery to allow for continuous flow of blood to the brain during repair.
Treatment of carotid body tumors
Treatment for carotid body tumors is generally very safe, and outcomes are generally very good. However, as with any surgical procedure, there are risks.
One possible complication of resection of carotid body tumors is stroke, but it occurs in less than 5 percent of patients. Most strokes are associated with large tumors requiring vascular repair or replacement. Some tumors involve the nerves that lie near the carotid artery, such as the vagus nerve. Curative resection, in these cases, requires concomitant resection of the vagus nerve, which may result in dysfunction of the nerve. Other nerves that may be involved include the facial nerve and the hypoglossal nerve (which controls the tongue). The risk of nerve involvement correlates directly to the size of the tumor.
Approximately 20 percent of patients develop a permanent cranial nerve dysfunction, but this varies depending on the size of the tumor. Metastatic disease develops in less than 5 percent of patients, and recurrence can occur in 5 to 10 percent of patients.
Special precautions are taken to decrease these risks, and there may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the procedure and why the procedure is recommended.