Adjunct endovascular interventions in carotid body tumors

Objective Most patients presenting with carotid body tumors (CBTs) seek medical attention when tumors have grown to exceed Shamblin I stage, rendering surgery a challenging undertaking and the associated morbidity a continuing threat to the clinical outcome. This study examined the availability, applicability, and overall clinical efficacy of adjunct endovascular interventions performed alongside CBT surgery and their potential in clinical decision making and clinical practice. Methods Studies reporting the feasibility, applicability, and clinical efficacy of adjunct endovascular interventions in the surgical management of CBTs were thoroughly searched using the Medline database from January 1967 to August 2013. Results There were no randomized studies on the efficacy of endovascular interventions in CBT surgery. Sixty studies met our inclusion criteria, reporting 465 patients (526 CBTs) with a mean age of 39.8 years. The treated CBTs were a mean size of 4.9 cm. Patients treated with surgery with the use of adjunct endovascular interventions had a mean blood loss of 368.4 mL (range, 25-to 2000 mL). There were 57 cranial nerve injuries, of which 28 (49.1%) were permanent. Cerebrovascular accident occurred in nine patients, of which one died. Hospital stay was a mean of 4.4 days (range, 2-17 days). Conclusions Preoperative selective endovascular embolization in patients with Shamblin II and Shamblin III CBTs may be beneficial when competently performed by interventional physicians proficient in neurovascular microcatheterization/embolization procedures.