Surgical management of malignancy-associated carotid sinus syndrome: a case report and literature review.

A 59-year-old male was admitted to hospital for workup of a high-grade atrioventricular block, where he had recurrent episodes of symptomatic bradycardia and hypotension. Imaging performed in anticipation of pacemaker insertion demonstrated a right-sided neck mass obliterating the jugular vein and compressing the carotid artery. He continued to have episodes of hemodynamic instability despite transvenous pacing. Decision was made to proceed with excisional biopsy and surgical debulking as a therapeutic attempt for suspected mass effect on the carotid sinus. Intraoperatively, there was gross vagus nerve invasion and no hemodynamic response to direct manipulation of the carotid sinus. The vagus nerve was transected to eliminate tumor-related parasympathetic neurotransmission. Pathology revealed a squamous cell carcinoma. The patient had radiographic and clinical improvement after treatment with chemoradiation. In a small number of similar cases, surgical resection of the tumor or intracranial section of the vagus nerve resulted in resolution of vasomotor symptoms, in conjunction with adjunctive treatments.