Management of Shamblin Type III Carotid Body Tumor With Preoperative Embolization, Surgical Resection, and Rescue Endovascular Stroke Treatment: A Case Report.

BACKGROUND This report describes the case of a 51-year-old woman with a history of transient ischemic attack and a diagnosis of a large Shamblin type III carotid body tumor (CBT) encasing the carotid artery. The CBT was managed by preoperative embolization and surgical resection, which was complicated by postoperative stroke and arterial damage requiring surgical repair. CBTs are usually slow-growing, pulsatile cervical tumors that can cause clinical symptoms secondary to catecholamine secretion in functional lesions or symptoms related to compression of adjacent structures in nonfunctional lesions. CASE REPORT The patient was diagnosed with CBT. Ten months prior, she had a transient ischemic attack with left-sided temporary hemiparesis. The surgical excision of the CBT was preceded by endovascular embolization. Despite this, significant bleeding occurred intraoperatively. The complete excision of the CBT was complicated by damage of the common carotid artery, with repair requiring temporal shunting. Two hours after surgery, the patient showed weakness of the left side of the body. Dissection of the right common and internal carotid arteries, occlusion of the external carotid artery, and a thrombus at the bifurcation of the right middle cerebral artery were identified on computed tomography. A successful endovascular intervention with stent implantation and mechanical thrombectomy was performed. Postoperatively, a slight face asymmetry and mild deterioration of upper limb mobility were observed, which resolved completely following successful rehabilitation. CONCLUSIONS Despite having a low incidence, CBTs remain a serious therapeutic problem. An interdisciplinary approach and availability of different specialties is key to successful treatment of complex CBTs.