CAROTID BODY TUMOR SURGERY

What is a carotid body tumour?

A carotid body tumour (also called a chemodectoma or paraganglioma) is a growth on the side of your neck in the area where the carotid artery splits off into smaller blood vessels that carry blood to your brain. You have two carotid arteries ─ one on each side of your neck ─ that supply blood to the front of the brain, which is responsible for thinking, speech, personality, and sensory and motor functions.

Symptoms

Many times, a carotid body tumour does not cause symptoms and is found by your doctor during an exam. You may be able to feel the tumour, but it is not painful.

If the tumour becomes large, it can press on the nerves, blood vessels or organs around it. This may cause throat pain, hoarseness, a numb tongue or make it hard to swallow.

Your doctor will closely examine your head and neck to check for signs of a carotid body tumour. You may need tests, such as:

  • Ultrasound – a test that uses a special tool (transducer/wand) that sends sound waves inside your body to create pictures.

  • Magnetic Resonance Imaging (MRI) – a test that uses a large magnet and radio waves to create detailed pictures of the inside of your body.
  • Computed Tomography (CT scan) – a special type of X-ray.
  • Magnetic Resonance Angiography (MRA) – an MRI that checks for problems with your blood vessels.
  • Specialised blood tests are requested in some conditions as carotid body tumours can occasionally be associated with some other rare conditions.

Carotid body tumours are not usually cancerous. But, they can grow quickly and become large. Because of this, the best treatment is often surgery to remove the tumour. In rare cases, radiation therapy is used.

Carotid Body Tumor Treatment

What surgical treatments are available for carotid body tumours?

For very large tumours the Vascular Surgical team works closely with the maxillofacial surgeons to offer patients a multidisciplinary approach to carotid body tumour treatment. Your healthcare team will create the best plan of care for you and give you detailed information about your procedure and recovery.

Surgical Removal (Resection)

Most times (60% -70%), the tumor can be removed without the need to repair or remove part of the carotid artery. If the artery does need to be repaired, it may be fixed with a simple suture repair. Sometimes, a more complicated repair is needed, such as creating a patch over a hole made during the tumor removal or replacing a section of the artery with bypass graft (using another blood vessel to create a new pathway for the blood to flow).

Transcatheter Embolization

Transcatheter embolization is a procedure that reduces blood supply to the tumour. This was a popular option some years ago as it was felt to make the surgery simpler. It is done two or three days before surgery. A catheter will be guided through your groin artery into the blood vessels that feed blood to the tumour. Then, medication and/or a blocking device, such as foam, plastic, metal coil, or glue is used to stop the blood flow to the tumour. Embolization also carries risks of damage to other tissues and hence is used only for very large tumors where the risks appear to be justified.

Risks of Treatment

Treatment for carotid body tumours is generally very safe with good outcomes. However, all surgery involves risks. One possible complication is stroke, but this is rare and happens in less than 2% of carotid body tumour removals. The risk is highest for patients who have large tumours and need to have vascular repair or replacement.

If the tumor affects the nerves near the carotid artery, such as the vagus nerve, facial nerve or hypoglossal nerve that controls your tongue, part of the nerve may need to be removed. This can cause problems with the affected nerve(s). The risk of nerve problems is higher if the tumor is large, but the overall risk of permanent nerve damage is less than 5%.

If the tumor is cancerous, there is a less than 5% chance it will spread to other areas of your body (metastatic disease).

The risk of having another carotid body tumor after surgery is 5% to 10%.

Your vascular surgeons take special precautions to decrease your risk of complications. Your surgeon will talk to you about these and other risks. Please make sure you understand why you need surgery, your risks, and ask your doctor any questions you have about your condition or treatment.

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