Should Pre-operative Embolization Be Utilized Routinely for Carotid Body Tumors Prior to Surgical Excision?

Carotid body tumors (CBT) are a type of paraganglioma that arise from extra-adrenal chromaffin cells at the carotid bifurcation usually deriving their blood supply from the external carotid artery. Surgery is the gold standard and is curative for resectable CBTs; however, these tumors can be large and surgical excision can lead to significant blood loss and morbidity. This chapter explores the efficacy of preoperative embolization prior to surgical resection of carotid body tumors. Five hundred and two studies were identified published between February 1998 and February 2018 including patients undergoing surgical intervention for cervical paragangliomas comparing the effects of preoperative versus no preoperative vascular embolization. There were 21 studies that met our criteria and addressed the utility of CBT resection with and without pre-operative embolization: two meta-analyses, two claims-based data multi-institutional studies, and 17 retrospective analyses. While Shamblin classification, tumor size, surgeon preference, operative time, blood loss, or tumor location are all cited as possible reasons for embolization there is no clear consensus in the literature on when to perform pre-operative embolization of carotid body tumors. Therefore, no recommendation can be made for the use of pre-operative embolization for surgical excision of carotid body tumors.