Tumors of the carotid artery usually arise from nerves of the autonomic nervous system. Fortunately, most of these tumors are benign, with only about 2-15% being malignant.
It is not uncommon for the tumor to be discovered by accident, since these tumors often do not give rise to any symptoms. You may have noticed the tumor because you developed a hoarse voice or a neck swelling. If you currently have a lump on your neck which has not been further investigated, you should have an ultrasound scan of the vessels or other imaging such as computed tomography or magnetic resonance imaging.
Paragangliomas of the carotid artery may be adherent to the vessel to a variable extent. The degree to which the tumor is fused to the vessel is decisive for the extent of surgery.
Mildly adherent tumors may often be removed without having to replace your carotid artery. An incision is made on the neck to search for the tumor, which is then carefully removed in its entirety from the carotid artery Obtained tissue is then sent for histological examination to determine whether the tumor is benign or malignant. A catheter-guided intervention may be required before the actual operation to obliterate the vessels supplying the tumor, depending on its size.
We may have to remove parts of your carotid artery if the tumor is greatly adherent to the vessel; the removed segment is then replaced by a patch. Your carotid artery may need to be removed if the tumor is markedly adherent and the vessel is then replaced by a plastic tube. This also requires an incision in the neck; we then search for the tumor and attempt to remove it from the vessel. Should this be unsuccessful, we briefly clamp off your artery and then remove the affected segment. The defect is then replaced by a patch or a plastic tube. The incision in the neck is then sutured with self-dissolving sutures running through the skin. A drain is placed to enable drainage of wound secretions which is usually removed on the first or second post-operative day.
You should let us know beforehand if you are taking blood thinners to enable us to decide which medication you should withhold and for how long before surgery. We will also decide whether you may continue taking your medication.
Suture removal is not required since we use self-dissolving sutures. A follow-up ultrasound of the carotid arteries should be undertaken six weeks later. You may undergo this study at the University Hospital Zurich. Regular follow-up by an oncologist is also essential, depending on the results of histology. You should also undergo an annual ultrasound of the carotid arteries, including that of the opposite side, since the tumor can occur on both sides.
Interdisciplinary teams comprised of angiologists, vascular surgeons, oncologists and radiologists treat several patients annually at the University Hospital Zurich. Our doctors thus have extensive experience in diagnosing and monitoring the clinical course of paragangliomas.
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University Hospital Zurich
Clinic for Vascular Surgery