Asian Cardiovasc Thorac Ann 2006;14:528-529
© 2006 Asia Publishing EXchange Ltd
Effective Bleeding Control During Resection of Giant Carotid Body Tumor
A Kubilay Korkut, MD,
Hasan Lice, MD1,
Nadir Aygutalp, MD1
Yedikule Teaching and Research Hospital for Chest Disease and Thoracic Surgery
1 Haseki Teaching and Research Hospital, Istanbul, Turkey
For reprint information contact: A Kubilay Korkut, MD Tel: 90 212 661 3304 Fax: 90 212 543 7388 Email: kubilaykorkut{at}superonline.com, Atakoy 9. Kisim, D-7-B Kapisi, D:15, Istanbul 34156, Turkey.
 |
ABSTRACT
|
|---|
Carotid body tumor is a rare neoplasm located at the carotid bifurcation. Ligation and excision of the external carotid artery together with the tumor is preferred in patients with transmural tumor invasion. In those without transmural tumor invasion, temporary occlusion of the external carotid artery at the bifurcation allows trouble-free tumor excision and keeps the external carotid artery intact.
|
INTRODUCTION
|
|---|
Carotid body tumors (CBT) are rare neoplasms that arise at the carotid artery bifurcation. Surgery is essential for CBT. Despite technological advances and increased surgical experience, complete resection of the tumor is still associated with a 5% rate of cerebrovascular complications and 20% incidence of permanent cranial nerve injuries.1 The complication rate increases in large and invasive tumors. Intraoperative bleeding is a problem during complete resection of a giant CBT. A large amount of bleeding prolongs the operation time and requires blood transfusion, which increases morbidity, especially in patients with cardiac and renal failure. These tumors carry a higher blood flow per gram than any other tumor. The primary blood supply is from the external carotid artery and its branches. Therefore, to reduce hemorrhage, blood flow in the external carotid artery must be controlled.
|
TECHNIQUE
|
|---|
With the patient in the supine position under general anesthesia, the head is turned away from the affected side, and the neck is elevated slightly. An incision is started from the mastoid process to the superior border of the clavicle and extended along the anterior border of the sternocleidomastoid muscle. The dissection is continued until the common carotid artery is found and surrounded with a tape. The vagus and the hypoglossal nerve are dissected free carefully. To control blood flow in the external carotid artery, it is dissected free at the bifurcation and temporarily occluded with 2/0 silk sutures. This reduces the size of the giant CBT immediately. The tumor can be excised quickly, without any significant blood loss, in the periadventitial plane.
|
DISCUSSION
|
|---|
A 60-year-old woman was admitted with a mass on the left side of her neck. A deep-tissue rigid immovable mass was determined on physical examination. A mass of 8 x 10 cm at the bifurcation of the carotid artery was seen on magnetic resonance imaging. A diagnosis of giant CBT was verified by digital subtraction angiography. Magnetic resonance imaging revealed that the internal carotid artery was free of involvement, but the tumor was attached to the external carotid artery. The external carotid artery had a small diameter and poor run-off on digital subtraction angiography. Surgical excision was undertaken using the technique described above. The patient was extubated in the operating room and discharged on the 2nd postoperative day without any surgical or neurological problems.
Shamblin and colleagues2 described 3 anatomic groups of CBT. Group I comprises relatively small tumors that are minimally attached to the carotid vessels; surgical excision is not difficult. Group II tumors are larger with moderate attachments. They can be resected, but many patients require a temporary intraluminal carotid shunt. Group III tumors are very large neoplasms that encase the carotid arteries and often require arterial resection and grafting. Surgical excision is very difficult and complicated in this group. Preoperative evaluation does not give precise information about the degree of adhesion between the tumor and the carotid arteries, feeding vessels, potential blood loss, or cerebrovascular and nerve injuries.3 Some techniques to decrease blood loss and facilitate resection of the CBT have been described. Preoperative embolization decreases vascularity and improves the safety of surgical excision with less blood loss, but it may produce thrombosis of the internal carotid artery or cerebral embolization.4 When there is transmural tumor invasion of the external carotid artery, ligation and resection of the artery with the tumor mass may be required. However, if the internal carotid artery is attached, saphenous vein interposition is necessary.5 The distal part of the internal carotid artery should be clearly tumor-free.
In patients with a small tumor and no invasion of the external carotid artery, excision of the mass with preservation of the arterial system is essential. In these cases, temporary occlusion of the external carotid artery reduces the tumor mass and minimizes blood loss (Figure 1
). This method should allow trouble-free tumor excision and keep the external carotid artery intact. However, in the case of a large tumor with external carotid artery invasion, ligation of the artery at the bifurcation and resection along with the tumor mass is essential.
View larger version (124K):
[in this window]
[in a new window]
|
Figure 1. Occlusion of the external carotid artery with a ligature allows total resection of the tumor mass without any serious complications.
|
|
|
REFERENCES
|
|---|
- van der Mey AG, Jansen JC, van Baalen JM. Management of carotid body tumors. Otolaryngol Clin North Am 2001;34: 907–24.[Medline]
- Shamblin WR, ReMine WH, Sheps SG, Harrison EG Jr. Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases. Am J Surg 1971;122:732–9.[Medline]
- Yoshida K, Maeda K, Suzuki M, Mogi G. Three cases of carotid body tumor—the usefulness of preoperative radiological studies and embolization. Nippon Jibiinkoka Gakkai Kaiho 2002;105: 759–62.[Medline]
- Pandya SK, Nagpal RD, Desai AP, Purohit AT. Death following external carotid arterial embolization for a functioning glomus jugular chemodectoma. J Neurosurg 1978;48:1030–4.[Medline]
- Whitehill TA, Krupski WC. Uncommon disorders affecting the carotid arteries. In: Rutherford’s vascular surgery. 5th ed. Philadelphia: Saunders, 2000:1853–81.
TOP
ABSTRACT
INTRODUCTION
