Risk factors for stroke during surgery for carotid body tumors.

BACKGROUND

Removing carotid body tumors (CBTs) carry the risk of operative morbidity including stroke. We evaluated the risk factors for stroke related to resection of CBTs.

METHODS

We retrospectively reviewed the records of 17 procedures performed on 16 patients with CBT between March 1998 and September 2008.

RESULTS

The study population consisted of 5 men and 11 women, of mean age 41.7 years (range: 23-62 years). At surgery, 8 cases (47%) were localized and classified as Shamblin class I, 4 cases (23.5%) as class II, and 5 cases (29.4%) as class III. Four patients had postoperative stroke (23.5%), with Shamblin classification related to the incidence of stroke (P = 0.041). In contrast, neither tumor size (P = 0.412) nor heparin injection before internal carotid artery (ICA) manipulation (P = 0.538) was associated with stroke. Although preoperative embolization of the tumor feeder did not significantly reduce the stroke rate (P = 0.579), early external carotid artery (ECA) division in patients with class II and III tumors was effective (P = 0.008). Internal carotid artery (ICA) manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke (P = 0.029), as did ICA ligation without reconstruction (P = 0.044).

CONCLUSIONS

Internal carotid artery manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke. For uncomplicated CBT resection, careful preoperative planning, especially for patients with class II and III tumors, is mandatory to avoid inadvertent ICA manipulation necessitated by bleeding. Early ECA division during the operation rather than preoperative percutaneous embolization in patients with class II and III tumors was significantly effective in reducing the stroke rate.