CAROTID-BODY TUMORS - A DIAGNOSTIC AND TH ERAPEUTIC CHALLENGE

Within a population of 1150 vascular patients over a time period of 10 years we saw a carotid body tumor (synonymous chemodectoma) in only 1 1 cases. A correct preoperative diagnosis was found only in three pati ents. Before being treated by a specially trained team of vascular sur geons, eight patients had undergone inadequate operations. These were performed with a high incident of local complications. Simple bedside physical examination of the patient while looking for the signs of Fon taine and Kocher I + II (20) assures the diagnosis. Confirmation can b e achieved by color-flow Doppler sonography (2). For the surgical rese ction, the only therapeutic alternative to the ''gold standard'' is an giography in digital subtraction technique which illustrates the blood supply of the tumor (70 % exclusively by the external carotid artery) . Also, it shows the typical intercarotid widening and the rich vascul ar conglomerate in between. Malignancy was detected in one case only ( pulmonary metastasis). In two cases concomittant tumors of the jugular vein were seen. The interruption of the blood flow in the external ca rotid artery facilitates the surgical approach substantially. The liga ture of this vessel (six patients) and the interposition of saphenous vein grafts (all 11 cases) for reconstruction of the internal carotid vessel were employed as the surgical strategy. Even the exstirpation o f a large tumor (18 x 11 x 9 cm) extending from the skull base and alm ost reaching the left clavicular bone was successfully performed.Preop erative catheter embolization, as favored by LaMuraglia et al. (8), is in our opinion of no benefit for the patient, and may even be dangero us because of so-called ''deadly anastomoses'' with reversed flow betw een the internal carotid artery and the tumor vessels. At present, sur gical resection is the only satisfactory therapeutic approach to carot id body tumors yet available; it has a perioperative risk of 1% compar ed to the 30% mortality of the spontaneous progression of the tumor. T hus, operative exstirpation is the therapeutical approach of choice ev en in far advanced tumor stages.