Should Pre-operative Embolization Be Utilized Routinely for Carotid Body Tumors Prior to Surgical Excision?

  • Chris J. Britt
  • Wojciech K. MydlarzEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Carotid body tumors (CBT) are a type of paraganglioma that arise from extra-adrenal chromaffin cells at the carotid bifurcation usually deriving their blood supply from the external carotid artery. Surgery is the gold standard and is curative for resectable CBTs; however, these tumors can be large and surgical excision can lead to significant blood loss and morbidity. This chapter explores the efficacy of preoperative embolization prior to surgical resection of carotid body tumors. Five hundred and two studies were identified published between February 1998 and February 2018 including patients undergoing surgical intervention for cervical paragangliomas comparing the effects of preoperative versus no preoperative vascular embolization. There were 21 studies that met our criteria and addressed the utility of CBT resection with and without pre-operative embolization: two meta-analyses, two claims-based data multi-institutional studies, and 17 retrospective analyses. While Shamblin classification, tumor size, surgeon preference, operative time, blood loss, or tumor location are all cited as possible reasons for embolization there is no clear consensus in the literature on when to perform pre-operative embolization of carotid body tumors. Therefore, no recommendation can be made for the use of pre-operative embolization for surgical excision of carotid body tumors.


Carotid body Paraganglioma Tumor Embolization Surgical excision 


  1. 1.
    Pellitteri PK, Rinaldo A, Myssiorek D, et al. Paragangliomas of the head and neck. Oral Oncol. 2004;40(6):563–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Suarez C, Rodrigo JP, Mendenhall WM, et al. Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy. Eur Arch Otorhinolaryngol. 2014;271(1):23–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Kafie FE, Freischlag JA. Carotid body tumors: the role of preoperative embolization. Ann Vasc Surg. 2001;15(2):237–42.PubMedCrossRefGoogle Scholar
  4. 4.
    Chedid A, Jao W. Hereditary tumors of the carotid bodies and chronic obstructive pulmonary disease. Cancer. 1974;33(6):1635–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Saldana MJ, Salem LE, Travezan R. High altitude hypoxia and chemodectomas. Hum Pathol. 1973;4(2):251–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Kohler HF, Carvalho AL, Mattos Granja NV, Nishinari K, Kowalski LP. Surgical treatment of paragangliomas of the carotid bifurcation: results of 36 patients. Head Neck. 2004;26(12):1058–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Nora JD, Hallett JW Jr, O’Brien PC, Naessens JM, Cherry KJ Jr, Pairolero PC. Surgical resection of carotid body tumors: long-term survival, recurrence, and metastasis. Mayo Clin Proc. 1988;63(4):348–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Schick PM, Hieshima GB, White RA, et al. Arterial catheter embolization followed by surgery for large chemodectoma. Surgery. 1980;87(4):459–64.PubMedGoogle Scholar
  9. 9.
    Gupta AK, Purkayastha S, Bodhey NK, Kapilamoorthy TR, Kesavadas C. Preoperative embolization of hypervascular head and neck tumours. Australas Radiol. 2007;51(5):446–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Zeitler DM, Glick J, Har-El G. Preoperative embolization in carotid body tumor surgery: is it required? Ann Otol Rhinol Laryngol. 2010;119(5):279–83.PubMedCrossRefGoogle Scholar
  11. 11.
    Litle VR, Reilly LM, Ramos TK. Preoperative embolization of carotid body tumors: when is it appropriate? Ann Vasc Surg. 1996;10(5):464–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Abu-Ghanem S, Yehuda M, Carmel NN, Abergel A, Fliss DM. Impact of preoperative embolization on the outcomes of carotid body tumor surgery: a meta-analysis and review of the literature. Head Neck. 2016;38(Suppl 1):E2386–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Jackson RS, Myhill JA, Padhya TA, McCaffrey JC, McCaffrey TV, Mhaskar RS. The effects of preoperative embolization on carotid body paraganglioma surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;153(6):943–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Cobb AN, Barkat A, Daungjaiboon W, et al. Carotid body tumor resection: just as safe without preoperative embolization. Ann Vasc Surg. 2018;46:54–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Vogel TR, Mousa AY, Dombrovskiy VY, Haser PB, Graham AM. Carotid body tumor surgery: management and outcomes in the nation. Vasc Endovasc Surg. 2009;43(5):457–61.CrossRefGoogle Scholar
  16. 16.
    Ward PH, Liu C, Vinuela F, Bentson JR. Embolization: an adjunctive measure for removal of carotid body tumors. Laryngoscope. 1988;98(12):1287–91.PubMedCrossRefGoogle Scholar
  17. 17.
    LaMuraglia GM, Fabian RL, Brewster DC, et al. The current surgical management of carotid body paragangliomas. J Vasc Surg. 1992;15(6):1038–44, discussion 1044–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Tikkakoski T, Luotonen J, Leinonen S, et al. Preoperative embolization in the management of neck paragangliomas. Laryngoscope. 1997;107(6):821–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Kasper GC, Welling RE, Wladis AR, et al. A multidisciplinary approach to carotid paragangliomas. Vasc Endovasc Surg. 2006;40(6):467–74.CrossRefGoogle Scholar
  20. 20.
    Liu DG, Ma XC, Li BM, Zhang JG. Clinical study of preoperative angiography and embolization of hypervascular neoplasms in the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(1):102–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Ozay B, Kurc E, Orhan G, et al. Surgery of carotid body tumour: 14 cases in 7 years. Acta Chir Belg. 2008;108(1):107–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Arnold D, Bit N, Turel M, Shyamkumar NK, Stephen E, Agarwal S. Efficacy of preoperative embolization in management of carotid body tumours—a pilot study. Cent Eur J Med. 2009;4(3):337–9.Google Scholar
  23. 23.
    Li J, Wang S, Zee C, et al. Preoperative angiography and transarterial embolization in the management of carotid body tumor: a single-center, 10-year experience. Neurosurgery. 2010;67(4):941–8, discussion 948.PubMedCrossRefGoogle Scholar
  24. 24.
    Lim JY, Kim J, Kim SH, et al. Surgical treatment of carotid body paragangliomas: outcomes and complications according to the shamblin classification. Clin Exp Otorhinolaryngol. 2010;3(2):91–5.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Avgerinos ED, Moulakakis K, Brountzos E, et al. Advances in assessment and management of carotid body tumors. Vascular. 2011;19(5):250–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Power AH, Bower TC, Kasperbauer J, et al. Impact of preoperative embolization on outcomes of carotid body tumor resections. J Vasc Surg. 2012;56(4):979–89.PubMedCrossRefGoogle Scholar
  27. 27.
    Zhang TH, Jiang WL, Li YL, Li B, Yamakawa T. Perioperative approach in the surgical management of carotid body tumors. Ann Vasc Surg. 2012;26(6):775–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Bercin S, Muderris T, Sevil E, Gul F, Kilicarslan A, Kiris M. Efficiency of preoperative embolization of carotid body tumor. Auris Nasus Larynx. 2015;42(3):226–30.PubMedCrossRefGoogle Scholar
  29. 29.
    Mourad M, Saman M, Stroman D, Brown R, Ducic Y. Evaluating the role of embolization and carotid artery sacrifice and reconstruction in the management of carotid body tumors. Laryngoscope. 2016;126(10):2282–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Law Y, Chan YC, Cheng SW. Surgical management of carotid body tumor – is Shamblin classification sufficient to predict surgical outcome? Vascular. 2017;25(2):184–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Shamblin WR, ReMine WH, Sheps SG, Harrison EG Jr. Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases. Am J Surg. 1971;122(6):732–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Davidge-Pitts KJ, Pantanowitz D. Carotid body tumors. Surg Annu. 1984;16:203–27.PubMedGoogle Scholar
  33. 33.
    Matticari S, Credi G, Pratesi C, Bertini D. Diagnosis and surgical treatment of the carotid body tumors. J Cardiovasc Surg. 1995;36(3):233–9.Google Scholar
  34. 34.
    Maier W, Marangos N, Laszig R. Paraganglioma as a systemic syndrome: pitfalls and strategies. J Laryngol Otol. 1999;113(11):978–82.PubMedCrossRefGoogle Scholar
  35. 35.
    Merland JJ, Reizine D, Guimaraens L, et al. Diagnostic and therapeutic angiography in the evaluation and treatment of glomus jugulare tumors. Apropos of 32 cases. Neurochirurgie. 1985;31(5):358–66.PubMedGoogle Scholar
  36. 36.
    Ogura JH, Spector GJ, Gado M. Glomus jugulare and vagale. Ann Otol Rhinol Laryngol. 1978;87(5 Pt 1):622–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Leonetti JP, Donzelli JJ, Littooy FN, Farrell BP. Perioperative strategies in the management of carotid body tumors. Otolaryngol Head Neck Surg. 1997;117(1):111–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Valavanis A. Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions. AJNR Am J Neuroradiol. 1986;7(5):943–52.PubMedGoogle Scholar
  39. 39.
    Davila VJ, Chang JM, Stone WM, et al. Current surgical management of carotid body tumors. J Vasc Surg. 2016;64(6):1703–10.PubMedCrossRefGoogle Scholar
  40. 40.
    Dardik A, Eisele DW, Williams GM, Perler BA. A contemporary assessment of carotid body tumor surgery. Vasc Endovasc Surg. 2002;36(4):277–83.CrossRefGoogle Scholar
  41. 41.
    Kim GY, Lawrence PF, Moridzadeh RS, et al. New predictors of complications in carotid body tumor resection. J Vasc Surg. 2017;65(6):1673–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Wang SJ, Wang MB, Barauskas TM, Calcaterra TC. Surgical management of carotid body tumors. Otolaryngol Head Neck Surg. 2000;123(3):202–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OtolaryngologyLoyola University Medical CenterMaywoodUSA
  2. 2.Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBethesdaUSA

Personalised recommendations