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Carotid body tumour surgery. A report of seven patients.

The purpose of the present paper is to analyse diagnostic and therapeutic aspects of carotid body tumours. Seven patients with carotid body tumour underwent surgery at our department between 1982 and 1998. All of them had an asymptomatic cervical lateral mass. The preoperative evaluation included angiography in 7 patients, duplex scanning in 2 patients and computed tomography in one patient. Tumour excision was performed in 5. Carotid artery resection with the tumour was required in 2 patients and in both, interposition of a 5-mm polytetrafluoroethylene graft was performed. During the resection, temporary carotid shunt was required in one patient. Perioperative transcranial Doppler was used once; the use of a shunt during carotid artery resection was not required in the second case. All tumours were identified as carotid paragangliomas without evidence of malignancy. There was no mortality and no hemiplegia. After surgery, temporary cranial nerve dysfunction was noted in 2 cases. In the follow-up period of 2 to 14 years (mean, 7 years), no recurrent disease occurred. Patency of the grafts was good at 4 and 7 years after carotid artery reconstruction. We conclude that with non-invasive investigation and arteriography it is possible to obtain an early and precise diagnosis. The decision to perform simple tumour excision or additional arterial resection is based on diagnostic preoperative as well as intraoperative evaluation of the individual tumour. As demonstrated in our cases, after resection of the internal carotid artery a polytetrafluoroethylene graft may be used for carotid reconstruction. Early surgery is recommended because it minimises the risk of complications associated with large tumours.