Role of malignancy and preoperative embolization in the management of carotid body tumors

The purpose of this retrospective study is to present our approach to the m anagement of patients with carotid body tumors (CBTs), emphasizing the role of malignancy and preoperative embolization. Between 1975 and 1998 a serie s of 18 patients with CBTs were treated, and 16 of them underwent successfu l excision of the tumor. According to the Shamblin classification, six of t he tumors were type I, six type II, and six type III. In three of these pat ients (two with type II tumors and one with type III) in whom preoperative embolization had been performed, mean intraoperative blood loss was 400 mi, whereas in the remaining 13 cases this loss was 700 mi. Two patients with intracranial tumor spread underwent only radiotherapy. Neither postoperativ e deaths nor strokes occurred. Temporary cranial nerve injury occurred in f our cases (25%). Local lymph node invasion was found in two patients, estab lishing the diagnosis of malignancy. One of these patients developed distal metastases 3 years after the operation and was treated with radiotherapy a nd octreotide. Follow-up ranging from 30 months to 23 gears (mean 5 gears) revealed no local recurrence except for the two patients who were treated w ith radiotherapy only. In conclusion, surgical excision remains the treatme nt of choice for CBTs and can be performed,without major risks and with low morbidity and mortality. Preoperative embolization is helpful by diminishi ng intraoperative bleeding, and malignancy, though rare justifies early man agement.