Large Carotid body Tumors - Neurovascular importance
Large carotid body tumors are generally highly vascular and difficult to remove. The vascularity of these tumors is reduced by preoperative embolization. But during surgery we are still finding multiple small neck blood arising from the bifurcation area and they are difficult to clipped are tied with 6 or 7 zero prolene. In the recent past we had to plan a bypass from the common carotid artery to the internal carotid artery with vein graft before the carotid artery clamped dissected out along with the tumor and external carotid artery. It was  not possible to save the Vagus which was entangled in the tumor. Hypoglossal nerve was saved. Accessory nerve was partially damaged. The internal jugular vein was preserved. Post operative patient had difficulty in deglutition with husky voice. The preoperative imaging and embolization, Intra-operative magnification and improvement in the skills has made this possible to remove the large tumors with bypass, but nerve injuries are difficult to prevent and manage. Some times the tumors are arising from these nerves.