Diagnosis and treatment of carotid body tumors

Purpose: To investigate the clinical diagnosis, treatment, and complication prevention of carotid body tumors (CBTs). Methods: The medical records of 24 patients with CBTs treated in the Department of Oral and Maxillofacial Surgery in Shandong Provincial Hospital Affiliated to Shandong First Medical University from 1999 to 2014 were reviewed. All the patients had unilateral CBTs and underwent preoperative B-mode ultrasound. Before surgery, CBT diagnosis was confirmed by digital subtraction angiography (DSA) in 8 patients, magnetic resonance imaging (MRI) in 9 patients, and computed tomography angiography (CTA) in 11 patients. All the patients had surgical intervention and preoperative Matas test. The retrograde stump pressure in the internal carotid artery was monitored in all the cases during surgery. Transcranial Doppler (TCD) inspection was performed on all patients before and during surgery. Simple tumor resection was performed in 8 patients, and excision of both the tumor and external carotid artery was performed in 11 cases. Five patients received intraluminal shunt after tumor resection and partial removal of internal, external, and common carotid arteries. Results: The diagnostic accuracy of B-mode ultrasound, DSA, MRI, and CTA was 75%, 100%, 88.9%, and 90.9%, respectively. In the enrolled 24 patients, tumors were completely removed with no postoperative death, hemiplegia, or blindness. There were 4 cases of transient hypoglossal nerve palsy and 1 case of transient vagus nerve involvement after surgery, which were recovered after 4-8 months of follow-up. No recurrence was found in the included patients during the followed-up, varied from 3 months to 4 years. B-mode ultrasound examination can be used as a preliminary screening method. DSA, CTA, and MRI are all effective diagnostic tools for CBTs. Among them, the diagnostic coincidence rate of DSA is 100%, making it the most effective means of inspection. Surgical resection is the first choice for the treatment of CBT patients who are willing to undergo surgery. Conclusions: Preoperative routine Matas test can improve the brain tolerance of patients with carotid artery occlusion, preoperative, and intraoperative TCD monitoring are beneficial to understand the intracranial circulation in the circle of Willis. Intraoperative monitoring of residual arterial pressure and intraluminal shunt can prevent or significantly reduce the incidence of serious postoperative complications.