World’s First Reported Successful Surgery for Rare Carotid Body Tumour in Patient with Previous Angioplasty and Coronary Stent
Mumbai: In what is being described as a world’s first reported successful surgical case of its kind, a multidisciplinary team at Wockhardt Hospitals, Mira Road has successfully removed a rare and highly vascular carotid body tumour from a 60-year-old woman with significant pre-existing heart disease and a history of angioplasty and coronary stent placement.
The patient had undergone angioplasty in 2016 after being diagnosed with approximately 90% coronary artery blockage, following which a coronary stent was inserted. Years later, she developed a rare carotid body tumour located close to major blood vessels and critical nerves of the neck. The combination of a highly vascular tumour, previous coronary intervention and the need for careful management of antiplatelet therapy made the surgery particularly complex.
The challenging procedure was performed by Dr. Chandraveer Singh, Consultant Head & Neck Cancer Surgeon; Dr. Vinod Rambal, Consultant Neurosurgeon; and Dr. Sheetal Radia, Consultant ENT & Head & Neck Cancer Surgeon, at Wockhardt Hospitals, Mira Road.
Preoperative CT angiography revealed a well-defined, intensely enhancing lesion at the left carotid sheath at the C2–C3 level, causing characteristic splaying of the internal and external carotid arteries and partially encasing the internal carotid artery by less than 180 degrees. The findings were consistent with a Shamblin Group II carotid body paraganglioma.
The patient’s cardiac history further increased the surgical challenge. She was receiving antiplatelet therapy, including clopidogrel, creating a delicate balance between protecting her from cardiac complications and managing the considerable bleeding risk associated with surgery around the carotid circulation.A transverse cervical incision provided adequate exposure, following which the carotid sheath and major vessels were carefully identified. The common, internal and external carotid arteries were individually exposed and preserved. The tumour was meticulously dissected from the surrounding vascular structures and successfully excised without carotid wall injury. Importantly, the vagus and hypoglossal nerves were also preserved.
The patient’s postoperative recovery was highly satisfactory. On the first postoperative day, she was conscious, oriented and haemodynamically stable, with no significant neck swelling or postoperative haematoma. Neurological and cranial nerve examinations were reassuring, with normal facial movements, no tongue deviation, preserved shoulder elevation, good voice quality and satisfactory swallowing. No focal neurological deficit was observed.
Consultant Head & Neck Cancer Surgeon from Wockhardt Hospitals Mira Road Dr. Chandraveer Singh said, “This was an exceptionally challenging case because we were dealing with a highly vascular carotid body tumour located immediately adjacent to the major carotid vessels and critical nerves, while the patient also had significant cardiac history. Our multidisciplinary approach allowed us to meticulously dissect and remove the tumour while preserving the carotid arteries and important cranial nerves. The patient’s smooth postoperative recovery without neurological or cranial nerve deficits is a highly encouraging outcome.”
While there is no reliable international registry to conclusively establish the exact number of similar cases performed worldwide, the hospital considers the combination of a rare highly vascular carotid body tumour, previous angioplasty and coronary stent placement, antiplatelet therapy, and successful preservation of carotid circulation and cranial nerve function to be exceptionally rare and clinically noteworthy. The patient remains stable and is recovering satisfactorily at Wockhardt Hospitals, Mira Road.
