Preoperative Embolization Benefit for Patients Undergoing Carotid Body Tumor Surgery

Purpose: Carotid body tumors (CBTs), a special entity of head and neck paragangliomas, are rare with an incidence of 0.03% of all tumors. CBTs originate from neuroendocrine tissue at the carotid bifurcation. CBTs present as slowly growing, highly vascularized tumors. Preoperative transarterial embolization can facilitate resection of the highly vascularized tumors, yet the benefit of this procedure could not be demonstrated clearly. The purpose of in this study was to assess the results of CBT embolization with a focus on patient safety and on selection criteria for individual treatment decision.

Materials and Methods: Included in the analysis were all consecutive patients operated for CBT from 1988 to 2018. The prospectively collected data in a dedicated database were analyzed retrospectively. Diagnosis was confirmed using ultrasonography and magnetic resonance angiography. After approval by the university ethics committee and informed consent, genetic testing for SDH mutations was initiated routinely in 2006. Preoperative embolization was performed by experienced interventional radiologists using microcatheter techniques.

Results: A total of 80 patients underwent resection of 91 CBTs (57 women, 23 men; age, 24–86 years, mean age, 55.7 + 16.4 years). In 4 patients, a tumor recurrence or lymph node infiltration was diagnosed (malignant CBT). Genetic testing detected SDH mutations in 47% (28 of 57 patients). Tumor diameter was 1.1 to 7.2 cm. Fourteen patients with a mean tumor diameter of 4.6 cm (range, 2.0–6.2 cm) underwent preoperative embolization after interdisciplinary discussion. In 1 patient (a 75-year-old man), the embolization could not be completed because of the development of a temporary neurologic deficit during the procedure (ipsilateral transitory ischemic attack). No other adverse effects from embolization were observed. Blood loss and operating times did not differ. However, the subjective impression of the operating surgeons was that the tumor resection was facilitated by the embolization.

Conclusions: Preoperative embolization in carotid body tumors is a safe and effective strategy in carotid paragangliomas with rare neurologic complications. Criteria for optimized patient selection to develop individualized preoperative strategies and clear recommendations on candidates for embolization have yet to be identified. Because of the rarity of the tumor, a randomized trial is difficult to organize.