Carotid body tumors: The role of preoperative embolization

Resection of carotid body tumors (neck paragangliomas) carries inherent ris ks of injury to the cranial nerves and other structures as well excessive b lood loss. Preoperative embolization has been used to lessen the morbidity in tumors that are larger than 2 cm in diameter. Two female patients presen ted for treatment with large asymptomatic carotid body tumors-one 4 cm and one 5 cm in diameter. Both patients had preoperative angiography the day be fore surgery that revealed the feeding arterial vessels so that successful embolization could be accomplished with gel. Success was judged by diminuti on of the angiographic blush. Both patients had an uneventful surgical exci sion the following day with the carotid body tumors being able to be resect ed periadventitially without damage to either the external or internal caro tid artery. The cranial nerves were preserved in both patients and blood lo ss was only 200 cc in both cases. We conclude that preoperative embolizatio n is an important adjunct in treating patients with large carotid body tumo rs. The surgical exploration proceeds much smoother, the blood loss is mini mal, and patients have minimal morbidity.