PREOPERATIVE EMBOLIZATION OF CAROTID-BODY TUMORS - WHEN IS IT APPROPRIATE

To determine when to use preoperative embolization, we retrospectively reviewed a consecutive series of concurrently treated patients who un derwent carotid body tumor resection between 1984 and 1994. Eleven non embolized tumors (N-EMB group) and 11 embolized tumors (EMB group) wer e resected. The two groups were similar with respect to demographics a nd presentation, with the exception that more patients in the EMB grou p complained of painful neck masses. There was no significant differen ce in the pretreatment size of the neck mass between the two groups (N -EMB = 4.3 +/- 1.5 cm; N-EMB = 5.1 +/- 2.1 cm). Zero to 6 days after e mbolization, surgical resection was performed. There was no difference in the distribution of tumors, which were grouped according to Shambl in's classification, between the N-EMB and EMB patients. Two patients in each group required resection of the internal carotid artery, where as a total of seven cranial nerves were resected. There were no differ ences in blood loss, number of blood transfusions, operative time, or perioperative morbidity between the N-EMB and EMB groups. Ten patients had new cranial nerve deficits and four of these patients required tr eatment for tenth nerve paralysis. Overall the total hospital stay was similar in the two groups, but the EMB group had a significantly long er preoperative stay compared to the N-EMB group (1.5 +/- 0.8 vs. 0.8 +/- 0.4 days; p = 0.02). These data show that preoperative embolizatio n does not significantly improve outcome in patients undergoing resect ion of carotid body tumors measuring 4 to 5 cm. Therefore, in this era of cost-containment, preoperative embolization should not be used in the treatment of midsized carotid body tumors.