Carotid Body Tumors

  • Frank M. Davis
  • Andrea Obi
  • Nicholas OsborneEmail author


Carotid body tumors (CBTs) are the most common type of paraganglioma found in the neck. CBTs are slow-growing tumors that characteristically splay the carotid bifurcation and can encapsulate the external or internal carotid artery. Clinically, CBTs usually present as an asymptomatic anterior neck mass. In larger tumors, they can be associated with neck fullness, pain, dysphagia, odynophagia, hoarseness, and stridor. CBTs are typically classified into three groups that related to the difficulty of resection using the Shamblin classification. CBTs are frequently diagnosed by clinical examination or found incidentally on imaging studies. Color-flow duplex is the ideal initial diagnostic test for CBTs. CBTs appear as a characteristically well-defined hypoechoic mass that splays the carotid bifurcation and is hypervascular. Cross-sectional studies, such as CT angiography (CTA) or MRA, are increasingly used to determine the relationship of the tumor with the artery bifurcation and the likely location of the cranial nerves. CBTs classically receive their blood supply from the external carotid artery through multiple small branches of the ascending pharyngeal artery. Difficulty of resection of these tumors is determined by their size and involvement with adjacent structures. Occasionally, preoperative embolization of the ascending pharyngeal artery can be performed for large tumors; however, this may lead to increased inflammation when surgery is delayed more than 1–2 days. Resection of these tumors may require reconstruction of the internal carotid artery with either patch or interposition graft (saphenous vein). Complications include bleeding, cranial nerve injury (as high as 20–25%), and loss of the baroreceptor reflex. Stroke is a rare complication of this surgery.


Carotid body tumor Shamblin classification Paraganglioma 


  1. 1.
    Sajid MS, Hamilton G, Baker DM, Joint Vascular Research Group. A multicenter review of carotid body tumour management. Eur J Vasc Endovasc Surg. 2007;34:127–30.CrossRefGoogle Scholar
  2. 2.
    Kohn JS, Raftery KB, Jewell ER. Familial carotid body tumors: a closer look. J Vasc Surg. 1999;29:649–53.CrossRefGoogle Scholar
  3. 3.
    Hallett JW, Nora JD, Hollier LH, Cherry KJ, Pairolero PC. Trends in neurovascular complications of surgical management for carotid body and cervical paragangliomas: a fifty-year experience with 153 tumors. J Vasc Surg. 1988;7:284–91.CrossRefGoogle Scholar
  4. 4.
    Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, Granados-Garcia M, Herrera-Gomez A. Carotid body tumors: review of a 20-year experience. Oral Oncol. 2005;41:56–61.CrossRefGoogle Scholar
  5. 5.
    Baysal BE, Ferrell RE, Willett-Brozick JE, et al. Mutations in SDHD, a mitochondrial complex II gene, in hereditary paraganglioma. Science. 2000;287:848–51.CrossRefGoogle Scholar
  6. 6.
    Pasini B, Stratakis CA. SDH mutations in tumorigenesis and inherited endocrine tumours: lesson from the phaeochromocytoma-paraganglioma syndromes. J Intern Med. 2009;266:19–42.CrossRefGoogle Scholar
  7. 7.
    Boedeker CC, Neumann HPH, Maier W, Bausch B, Schipper J, Ridder GJ. Malignant head and neck paragangliomas in SDHB mutation carriers. Otolaryngol Head Neck Surg. 2007;137:126–9.CrossRefGoogle Scholar
  8. 8.
    Jansen JC, van den Berg R, Kuiper A, van der Mey AG, Zwinderman AH, Cornelisse CJ. Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal. Cancer. 2000;88:2811–6.CrossRefGoogle Scholar
  9. 9.
    Westerband A, Hunter GC, Cintora I, Coulthard SW, Hinni ML, Gentile AT, Devine J, Mills JL. Current trends in the detection and management of carotid body tumors. J Vasc Surg. 1998;28:84–92.CrossRefGoogle Scholar
  10. 10.
    Young AL, Baysal BE, Deb A, Young WF. Familial malignant catecholamine-secreting paraganglioma with prolonged survival associated with mutation in the succinate dehydrogenase B gene. J Clin Endocrinol Metab. 2002;87:4101–5.CrossRefGoogle Scholar
  11. 11.
    Power AH, Bower TC, Kasperbauer J, Link MJ, Oderich G, Cloft H, Young WF, Gloviczki P. Impact of preoperative embolization on outcomes of carotid body tumor resections. J Vasc Surg. 2012;56:979–89.CrossRefGoogle Scholar
  12. 12.
    LaMuraglia GM, Fabian RL, Brewster DC, Pile-Spellman J, Darling RC, Cambria RP, Abbott WM. The current surgical management of carotid body paragangliomas. J Vasc Surg. 1992;15:1038–44.CrossRefGoogle Scholar
  13. 13.
    Kasper GC, Welling RE, Wladis AR, CaJacob DE, Grisham AD, Tomsick TA, Gluckman JL, Muck PE. A multidisciplinary approach to carotid paragangliomas. Vasc Endovasc Surg. 2007;40:467–74.CrossRefGoogle Scholar
  14. 14.
    Spinelli F, Massara M, La Spada M, Stilo F, Barillà D, De Caridi G. A simple technique to achieve bloodless excision of carotid body tumors. J Vasc Surg. 2014;59:1462–4.CrossRefGoogle Scholar
  15. 15.
    Rao USV, Chatterjee S, Patil AA, Nayar RC. The “INT-EX Technique”: internal to external approach in carotid body tumour surgery. Indian J Surg Oncol. 2017;8:249–52.CrossRefGoogle Scholar
  16. 16.
    Paridaans MPM, van der Bogt KEA, Jansen JC, Nyns ECA, Wolterbeek R, van Baalen JM, Hamming JF. Results from Craniocaudal carotid body tumor resection: should it be the standard surgical approach? Eur J Vasc Endovasc Surg. 2013;46:624–9.CrossRefGoogle Scholar
  17. 17.
    van der Bogt KEA, Vrancken Peeters M-PFM, van Baalen JM, Hamming JF. Resection of carotid body tumors: results of an evolving surgical technique. Ann Surg. 2008;247:877–84.CrossRefGoogle Scholar
  18. 18.
    Fisher DF, Clagett GP, Parker JI, Fry RE, Poor MR, Finn RA, Brink BE, Fry WJ. Mandibular subluxation for high carotid exposure. J Vasc Surg. 1984;1:727–33.CrossRefGoogle Scholar
  19. 19.
    Kim GY, Lawrence PF, Moridzadeh RS, et al. New predictors of complications in carotid body tumor resection. J Vasc Surg. 2017;65:1673–9.CrossRefGoogle Scholar
  20. 20.
    Davila VJ, Chang JM, Stone WM, Fowl RJ, Bower TC, Hinni ML, Money SR. Current surgical management of carotid body tumors. J Vasc Surg. 2016;64:1703–10.CrossRefGoogle Scholar
  21. 21.
    Torrealba JI, Valdés F, Krämer AH, Mertens R, Bergoeing M, Mariné L. Management of carotid bifurcation tumors: 30-year experience. Ann Vasc Surg. 2016;34:200–5.CrossRefGoogle Scholar
  22. 22.
    Ketch T, Biaggioni I, Robertson R, Robertson D. Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia. Circulation. 2002;105:2518–23.CrossRefGoogle Scholar
  23. 23.
    Netterville JL, Reilly KM, Robertson D, Reiber ME, Armstrong WB, Childs P. Carotid body tumors: a review of 30 patients with 46 tumors. Laryngoscope. 1995;105:115–26.CrossRefGoogle Scholar
  24. 24.
    Gwon JG, Kwon T-W, Kim H, Cho Y-P. Risk factors for stroke during surgery for carotid body tumors. World J Surg. 2011;35:2154–8.CrossRefGoogle Scholar
  25. 25.
    Cobb AN, Barkat A, Daungjaiboon W, Halandras P, Crisostomo P, Kuo PC, Aulivola B. Carotid body tumor resection: just as safe without preoperative embolization. Ann Vasc Surg. 2017;46:54. Scholar
  26. 26.
    Ramesh A, Muthukumarassamy R, Karthikeyan VS, Rajaraman G, Mishra S. Pseudoaneurysm of internal carotid artery after carotid body tumor excision. Indian J Radiol Imaging. 2013;23:208–11.CrossRefGoogle Scholar
  27. 27.
    Hotze TE, Smith TA, Clagett GP. Carotid artery pseudo-pseudoaneurysm after excision of carotid body tumor. J Vasc Surg. 2011;54:864.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Frank M. Davis
    • 1
  • Andrea Obi
    • 1
    • 2
  • Nicholas Osborne
    • 1
    • 2
    Email author
  1. 1.Vascular SurgeryUniversity of MichiganAnn ArborUSA
  2. 2.Vascular SurgeryAnn Arbor Veterans Medical CenterAnn ArborUSA

Personalised recommendations