Giant carotid body paraganglioma: our approach to surgical excision

Abstract

BACKGROUND: Carotid body tumours typically present as an asymptomatic anterior neck mass. However, larger tumours can become symptomatic. Surgical excision is the primary treatment, often preceded by embolisation to reduce tumour haemorrhage and perioperative risks. This case report presents a case of a successful excision of a giant Shamblin III carotid body tumour.

CASE REPORT: We present a case of a 37-year-old woman, originally from Mozambique, with a decade-long painless, gradually growing pulsatile left cervical swelling and progressive dysphonia and dysphagia to solids. Cervical computed tomography angiography revealed an expansive hypervascular lesion centred in the left carotid space spanning from the left carotid bifurcation to the base of the skull, with approximate dimensions of π×8.1×5.5 cmπ×8.1×5.5cm. She had no impairment of cranial nerves but had a tumour-compressed upper airway. Further diagnostic investigations were carried out, and the diagnosis of dopaminergic-producing left Shamblin III carotid body tumour was made.

The patient underwent tumour embolisation followed by surgical excision the following day. Under general anaesthesia to safely protect the upper airway until tumour removal, the authors deployed detachable hydrocoils to occlude several ECA branches supplying the tumour. After 24 hours, a multidisciplinary team undertook surgical excision. During the procedure, a peripheral neuromonitoring system was used to minimise the risk of injury to the lower cranial nerves. A regular longitudinal exposure of the carotid vessels was conducted. After proximal control of the common carotid artery, an easily bleeding tumour was medially mobilised to enable internal carotid artery exposure and preservation. Due to the high adhesion of the tumour and complete encasement of the external carotid artery, the authors ligated this artery and reconstructed the CCA bifurcation with an end-to-end common-to-internal carotid anastomosis. She was extubated on postoperative day one and was discharged home after ten days, without neurological deficits.

CONCLUSIONS: The management of carotid paragangliomas, particularly those classified as Shamblin III, requires a multidisciplinary approach and refined surgical technique to ensure complete tumor removal without compromising essential structures. The combination of preoperative embolization and a well-planned surgical procedure resulted in an excellent outcome for the patient, with no neurological complications.