International Journal of Head and Neck Surgery

Register      Login

VOLUME 5 , ISSUE 3 ( September-December, 2014 ) > List of Articles


Paradigm Shift of Carotid Body Paraganglioma Surgical Technique from Caudocranial to Craniocaudal Dissection: Analysis of Recent Literature

Sudhir Naik, Rajshekar Halkud, A Nanjundappa, Siddharth Biswas, Ashok M Shenoy, Purshottam Chavan, KT Sidappa, SD Madhu

Citation Information : Naik S, Halkud R, Nanjundappa A, Biswas S, Shenoy AM, Chavan P, Sidappa K, Madhu S. Paradigm Shift of Carotid Body Paraganglioma Surgical Technique from Caudocranial to Craniocaudal Dissection: Analysis of Recent Literature. Int J Head Neck Surg 2014; 5 (3):119-125.

DOI: 10.5005/jp-journals-10001-1196

Published Online: 01-12-2015

Copyright Statement:  Copyright © 2014; The Author(s).



The classical Shamblin's classification predicts only vascular morbidity without remarking on the neurological morbidity, while the neurological damage increase with vessel ligation and reconstruction. A modified Shamblin's classification described by Luna-ortiz with incorporation of the Hallett's zones of injury has been studied here.

Materials and methods

We present a case series analysis of carotid body paraganglioma managed in our institute. The study included 17 patients, 14 females and three males with a mean duration of presentation of 6.82 months. All were imaged with multislicer computed tomography angiography (CTA) and magnetic resonance angiography (MRA) for preoperative assessment and operated in the craniocaudal technique. The tumors were graded according to the modified Shamblin's criteria: grades I (2), II (13), IIIa (2), IIIb (0).


All the preoperative assessment of grading matched with the intraoperative findings. External carotid artery (ECA) ligation was done in two cases, no internal carotid artery (ICA) ligation and reconstruction were done. Two cases of permanent damage to the 12th nerve, two vagal nerve weakness was seen. No stroke or mortality recorded. The tumor was confirmed on immunohistochemistry. The patients were followed up for 6 months to 5 years with a mean follow-up of 2.5 years.


Preoperative imaging assessment using multislicer computed tomography angiography (MSCTA) and MRA helps to measuring the circumferential vessel involvement in grade III tumors. So, a craniocaudal dissection with assessment of all the zones of injury reduced blood loss and minimized neurovascular complications.

How to cite this article

Halkud R, Shenoy AM, Nanjundappa A, Chavan P, Sidappa KT, Madhu SD, Biswas S, Naik SM. Paradigm Shift of Carotid Body Paraganglioma Surgical Technique from Caudocranial to Craniocaudal Dissection: Analysis of Recent Literature. Int J Head Neck Surg 2014;5(3):119-125.

PDF Share
  1. carotid body tumor in a 13yearold child: case report and review of the literature. J Vascul Surg 2008;47(3):874-880.
  2. Dignity of carotid body tumors: review of the literature and clinical experiences. chirurg 2009 Sep;80(9):854-863.
  3. Carotid body paraganglioma management and outcome. Eur J Sci Res 2009;37(4):567-574.
  4. Management for carotid body paragangliomas. Interactive cardio Vascular and Thoracic Surgery 2006;5(6):692-695.
  5. Presentation and management of carotid body tumors. J Pak Med Assoc 2003;53(7):306-310, 312.
  6. Familial carotid body tumors: incidence and impli cations. Annals of Vascular Surgery 1993 Mar;7(2):190-194.
  7. Surgical management of carotid body tumors. Ann Surg Oncol 2008;15(3):2180-2186.
  8. on behalf of joint vascular research G: a multicenter review of carotid body tumor management. Eur J Vasc Endovasc Surg 2007;34(2):127-130.
  9. Carotid body tumors: a review of 30 patients with 46 tumors. Laryngoscope 1995 Feb;105(2):115-126.
  10. Carotid body tumors: review of a 20year experience. Oral Oncol 2005;41(1):56-61.
  11. Trends in neurovascular complications of surgical management for carotid body and cervical management paragangliomas: a 50year experience with 153 tumors. J Vascul Surg 1988;17(7):284-291.
  12. contemporary presentation and evolution of management of neck paragangliomas. J Vascul Surg 2009 June;49(6):1365-1373.
  13. Risk factors for stroke during surgery for carotid body tumors. World J Surg 2011 Dec;35(12):2829-2830.
  14. Carotid body tumor resection: does the need for vascular reconstruction worsen outcome? Ann Vasc Surg 2006;20(4):435-439.
  15. Paragangliomas of the head and neck: the KMC experience. Ind J Otolaryngol Head Neck Surg 2011 Jan;63(1):62-73.
  16. Perioperative strategies in the management of carotid body tumors. otolaryngol Head Neck Surg 1997;117(1):111-115.
  17. carotid body tumors in inhabitants of altitudes higher than 2000 meters above the sea level. Head Neck 1998;20(5):374-378.
  18. Carotid body tumors. J Serbian Med Soc 1997;125(3):278-284.
  19. Surgical management of carotid body tumors. Otolaryngol Head Neck Surg 2000;123(3):202-206.
  20. Head and neck para gangliomas: value of contrast-enhanced 3D MR angiography. Am J Neuroradiol 2008;29(3):883-889.
  21. Carotid body tumors: objective criteria to predict the Shamblin group on MR imaging. Am J Neuroradiol 2008 Aug;29(7):1349-1354.
  22. Adjuvant techniques for the management of large carotid body tumors: a case report and review. Cardiovasc Surg 1999;Jan;7(1):139-145.
  23. A multidisciplinary approach to reducing morbidity and operative blood loss during resection of carotid body tumor. Surg Gynecol Obst 1989;168(3):166-170.
  24. Multiple glomus tumors. J Laryngol Otol 1992 Jun;106(6):538-543.
  25. From the archives of the AFIP. Paragangliomas of the head and neck: radiologicpathologic correlation. Armed Forces Institute of Pathology. Radiographics 1999 Nov-Dec;19(6):1605-1632.
  26. current trends in the detection and management of carotid body tumors. J Vasc Surg 1998;28(2):84-93.
  27. carotid chemodectomas. Experience with nine cases with reference to preoperative embolization and malignancy. Acta Chir Belg 1997;97(4):220-228.
  28. Vascularization of head and neck paragangliomas: comparison of three MR angiographic techniques with digital subtraction angiography. Am J Neuroradiol 2000 Jan;21(1):162-170.
  29. Fractionated stereotactic conformal radiotherapy in the management of large chemodectomas of the skull base. Int J Radiat oncol Biol Phys 2004 Apr 1;58(5):1445-1450.
  30. Distal internal carotid exposure: a simplified technique for temporary mandibular subluxation. J Vasc Surg 1990 Sep;12(3):319-325.
  31. Paragangliomas of the neck. Arch Surg 1992;23(3): 1441-1445.
  32. Br J Surg 2001;388(10):1382-1386.
  33. Glossopharyngeal nerve injury complicating carotid endarterectomy. J Vasc Surg 1987 Mar;5(3):469-471.
  34. Carotid body tumour: 30 years experience. Br J Surg 1986;73(1):14-16.
  35. Carotid body paraganglioma: review and surgical management. Eur J Plast Surg 2001;24(2): 58-65.
  36. Management of head and neck paragangliomas: review of 120 patients. Head Neck 2009;31(3):381-387.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.