Resection of a Left Carotid Body Tumor With Preoperative Embolization: 2-Dimensional Operative Video

Carotid body tumors (carotid body paraganglioma) are World Health Organization grade I tumors that arise from the paraganglion cells at the carotid bifurcation. Surgical excision is the treatment of choice, especially for hormonally active tumors.1 Preoperative embolization can be beneficial to surgical resection, specifically for large tumors and those with superior extension. The greatest benefits of embolization are a reduction in intraoperative blood loss and simplification of resection.2 Resection of these lesions can be included as part of a neurovascular practice because the local anatomy is familiar to these surgeons.3 Resection can be performed safely by well-trained neurosurgeons, with outcomes similar to those achieved by other specialists.4 We report the case of a woman in her mid-60s who presented with pulsatile tinnitus from a glomus jugular and symptomatic hypertensive episodes associated with a hormonally active carotid body tumor. The lesion was noted to have significant arterial supply from the ascending pharyngeal artery and other external carotid artery branches and was thus referred for endovascular embolization. Onyx embolization was performed for 3 distinct branches, which achieved 75% devascularization of the tumor. The patient then underwent surgical exposure of the carotid artery, with microsurgical dissection of the tumor away from the internal and external carotid arteries, which were laterally displaced and draped over the tumor. The lesion was resected en bloc with minimal blood loss. No changes were found on postoperative neurological examination, and the patient was discharged 2 days later. The patient provided consent for the procedure.Video is used with permission from Barrow Neurological Institute.