Operative Technique for Embolization and Resection of a Carotid Body Tumor.

Abstract

Carotid body tumors are rare, highly vascular paragangliomas that arise from neural crest-derived chemoreceptor cells of the carotid body, a specialized structure located at the carotid bifurcation adjacent to the carotid sinus and involved in oxygen and carbon dioxide sensing. For symptomatic or enlarging lesions, surgical resection remains the definitive treatment. Preoperative embolization can reduce vascularity and improve intraoperative safety as supported by the literature demonstrating its safety and efficacy.^1-3 This video demonstrates the microsurgical technique for resection of a carotid body tumor in a 79-year-old woman presenting with a 3-year history of left neck pain, paresthesia, and a palpable neck mass. Magnetic resonance angiography revealed a 2.6 × 3.0 cm left carotid body tumor splaying the internal and external carotid arteries. After preoperative embolization, the patient was positioned supine with the head turned contralaterally. A linear incision was made along the anterior border of the sternocleidomastoid, and dissection proceeded through the platysma to expose the carotid bifurcation. The internal jugular vein was mobilized laterally, and the carotid arteries were skeletonized to identify and preserve adjacent cranial nerves and vascular structures. The tumor was completely resected with preservation of the normal carotid vasculature and vagus nerve. The patient was discharged on postoperative day 1 and remained asymptomatic at 6-week follow-up. This case highlights the role of preoperative embolization, hybrid angiography-operating suites, and meticulous microdissection in achieving safe and definitive resection of complex carotid body tumors.