CURRENT TRENDS IN THE DETECTION AND MANAGEMENT OF CAROTID-BODY TUMORS

Purpose: Because the natural history of carotid body tumors is believe d to be unpredictable, immediate surgical removal has been recommended . The present study reviews our experience in the diagnosis and treatm ent of these uncommon lesions. Methods: The medical records of patient s who appeared for treatment with carotid body tumors between 1981 and 1997 were reviewed. Patients demographics, mode of presentation, imag ing and treatment modalities, Shamblin classification, and neurologic complications (stroke, cranial nerve injuries) were analyzed. Results. Over the past 16 years, 31 patients with 32 carotid body tumors have been evaluated, with an average follow-up of 3.2 years. The patients w ere arbitrarily classified into two groups on the basis of the mode of detection. Seventy percent (23 of 32) of the tumors discovered on cli nical or self-examination were classified as Group 1; 28% (9 of 32) of the tumors detected during duplex scanning for carotid artery disease (8) or MRT (1) were classified as Group 2. The mean size of chemodect omas found on palpation (4.3 +/- 1.7 cm) was larger than that of those detected by duplex ultrasound (2.7 +/- 1.0 cm; p < 0.05, by paired t test). Preoperative embolization was successfully performed in 5 of 6 instances of large tumors; the remaining patient suffered a procedure- related stroke. Thirty-one carotid body tumors were resected. In one c ase, the tumor was felt by the primary surgeon to be too small (0.9 x 0.7 cm on duplex scan) to warrant immediate excision; this patient is being followed by periodic duplex scanning. Five neurologic complicati ons were noted in Group 1, one after preoperative embolization and fou r after surgery. One cranial nerve injury occurred in Group 2. One pat ient had a large recur rent chemodectoma with clinical evidence of met astatic disease. Conclusion: The increasing use of sophisticated imagi ng modalities may allow earlier discovery of carotid body tumors befor e they can be clinically detected. Resection of carotid body tumors of all sizes in appropriate surgical candidates remains the standard of care. Unfortunately, resection of even small tumors is associated with a low but constant incidence of neurologic complications.