Management of sizeable carotid body tumor: Case report and review of literature
A 40-year-old Yemini woman was admitted to King Fahd Hospital of University, Alkhobar, Saudi Arabia with a progressively growing mass in the left anterolateral side of her neck of 5 years duration. She presented with neck tenderness, dizziness, increasing number of fainting attacks, and shortness of breath. There was no history of hoarseness, dysphagia, or palpitation and no family history of a similar condition. Her left pupil was slightly more contracted than the right pupil (Horner's syndrome). The rest of her neurologic examination was unremarkable. Indirect laryngoscopy revealed slightly impaired movement of left vocal cord. Contrast enhanced computed tomography (CECT) scan of the neck with subsequent CT angiograms of the carotids showed a 6.9 × 5 × 5.8 cm hypervascular solid left carotid space mass encasing the common carotid artery (CCA) and both internal CA (ICA) and external CA (ECA) and splaying the carotid bifurcation with no luminal narrowing or thrombosis [Figures and ]. There was no contralateral tumor. The tumor was diagnosed as carotid body paraganglioma of Shamblin group III. Horner's syndrome was due to tumor encasement of the left sympathetic chain. No preoperative embolization was performed. The tumor was surgically removed under locoregional anesthesia and supplemented with intravenous propofol after reconstruction of the CA. The hypoglossal and vagus nerves were identified during surgery and preserved. Part of CCA, ICA, and ECA were removed with tumor and ICA was reconstructed with polytetrafluroethylene (PTFE) graft [Figures and ]. Monitoring of the neurological status was achieved by simple clinical evaluation of the state of consciousness under local anesthesia, and by continuous regional oxygen saturation (rSO2), measured with a cerebral oximeter (Somanetics Invos cerebral oximeter). It was not necessary to place a shunt. Blood loss was about 450 ml. Postoperatively, a transient swallowing difficulty and tongue deviation developed probably due to stretching of the hypoglossal nerve during the operation. On laryngoscopic examination, left-sided vocal cord paralysis was aggravated. There was no cerebrovascular event after surgery. Histopathology examination confirmed the preoperative diagnosis of paraganglioma []. Six months after surgery, the patient could speak and swallow normally and her tongue deviation disappeared. Graft surveillance at 9 months revealed a patent graft with normal flow.