The results of diagnosis and surgical treatment of carotid chemodectomas
Introduction. Tumors of the carotid body (chemodectomas) - rare, mostly benign tumors that account for less than 0.5% of all tumors. They develop from the epithelioid cells derived from the neural crest. Carotid body is generally oval, it's diameter ranges from 0.1 to 0.5 cm. It is located on the rear surface of the carotid bifurcation. Carotid body plays an important homeostatic role. Chemoreceptors of the carotid body are sensitive to hypoxia, hypercapnia, and acidosis, and are involved in the control of breathing. Tumor can cause a variety of symptoms associated with the pressure of the surrounding tissue. A biopsy is contraindicated due to high risk of bleeding. Material end methods. Forty-seven patients (31 women and 16 men) were operated for carotid arterial chemodectoma in the department of surgical treatment of arterial pathology of Bakoulev Centre for cardiovascular surgery in the period from 1963 to 2014. The diagnosis was based on clinical data and imaging techniques. Epidemiological features of the disease, concomitant carotid arteries lesions, diagnostic, treatment and complications were analyzed. Two patients had bilateral disease. Diagnosis was based on anamnesis, physical examination, imaging techniques such as ultrasound, computed tomography, angiography, and magnetic resonance imaging. Surgical treatment was performed in all patients. Results. Deaths after surgery were not registered. Pares and paralysis of cranial nerves were observed in 52% of patients, which were solved in 1-2 months on conservative treatment. Relapses of the tumor were not registered during follow-up of up to 15 years. During histological examination diagnosis of carotid chemodectoma was confirmed in all 49 cases. Among benign types alveolar variant was prevalent (22 cases), rarely detected angioma similar - 9 and adenoma similar - 6. Malignancy structure was found in 12 (25%) cases. There was no recurrence of the disease during follow-up of up to 15 years. Conclusion. High degree of clinical suspicion and early diagnosis are the main criteria for a successful surgery. Surgical removal is the treatment of choice for carotid chemodectomas, and if performed by an experienced surgeon is to avoid serious complications.