Management of Carotid Bifurcation Tumors: 30-Year Experience

Background: The carotid bifurcation can host a variety of tumors requiring complex surgical management. Treatment requires resection and, in some cases, vascular reconstruction that may compromise the cerebral circulation. The most frequent lesion at this location is the carotid body tumor ( CBT). CBT are classified according to Shamblin in 3 types depending on the degree of carotid vessels encasement. Our main objective was to report our clinical experience managing carotid bifurcation tumors throughout the last 30 years. Methods: Between 1984 and 2014, we treated 30 patients with 32 carotid bifurcation tumors. There were 21 women and 9 men ( 2.3:1), with a mean age of 45.5 years ( 18e75). The most frequent presentation was an asymptomatic neck swelling or palpable mass localized at the carotid triangle ( 86.7%). Results: Thirty of 32 tumors were resected. Since 1994, computed tomography scan has been the most frequently used diagnostic imaging tool ( 80%), followed by magnetic resonance imaging. Angiography was used mainly during the first 10 years of the study period. Mean size of the tumor was 44.6 mm ( 20-73 mm). Nineteen ( 63%) were classified as Shamblin II and 6 ( 20%) as Shamblin's III. All specimens were analyzed by a pathologist; 28 tumors ( 93%) were confirmed as paragangliomas, 2 ( 7%) were diagnosed as schwannomas. Two patients underwent preoperative embolization of the CBT; 5 patients ( 17%) required simultaneous carotid revascularization, all of them Shamblin III. Mean hospitalization time was 4.5 days ( 1-35 days). Transient extracranial nerve deficit was observed in 7 patients ( 23.3%). Three patients ( Shamblin III) required red blood cells transfusion. One patient ( Shamblin III) underwent a planned en bloc excision of the vagus nerve. There was no perioperative mortality or procedure-related stroke. No malignancy or tumor recurrence were observed during follow-up. Conclusions: CBTs can be diagnosed on clinical grounds requiring vascular imaging confirmation. These infrequent lesions are generally benign. Early surgical removal by surgeons with vascular expertise avoids permanent neurologic and or vascular complications.