Using Flight Plan for Embolization Technique Based on Carotid Body Tumor Angiography to Improve Surgical Treatment of the Lesion: Report of Two Cases.

Abstract

Carotid body tumor (CBT) is a rare type of paraganglioma in head and neck region, with a high risk of surgical bleeding and nerve damage. Here we applied a new imaging tool termed "Flight Plan for Embolization" (FPFE) technique to better identify tumors' feeding arteries so that better dissection and bleeding control can be made to improve surgical outcomes. One 55-year-old female and one 67-year-old male patient presented to our hospital with an asymptomatic CBT on the right and left neck, respectively. Surgical resection was proposed due to the lesions' nature of being able to gradually enlarge to cause significant neurovascular invasion and even malignancy transformation. The two patients underwent a 3D-digital subtracted angiography (DSA) for tumors before surgery. With the FPFE technique, the blood supply source and intra-tumoral distribution of CBTs were clearly identified from the 3D-DSA data. Surgery was performed for the female and male patients at 17 and 3 days after the angiography, respectively. With the guidance of FPFE, we could easily identify and control feeding vessels of the lesions and resect CBTs with minimal bleeding and nerve damage. In our experience, "FPFE" technique can effectively identify CBTs' main blood supply source, and might help to improve the surgical treatment by providing better bleeding control and clearer surgical field.