Adjunctive Techniques for Large Carotid Body Tumors: Percutaneous Embolization and TCD Monitoring

Carotid body tumors are amongst the most vascular tumors encountered. Many surgeons opt for trans-arterial embolization using glue or onyx, or PVA particles for large tumors. Generally, the tumor blood supply arises from the external carotid branches. However, as the circulation is very variable, non-target organ embolization (especially of the brain) is a major concern. In the case shown, the principal feeding vessels derived from both the external carotid branches and from a very large ipsilateral vertebral artery. Adequate embolization would have required challenging vertebral and tumor circulation catheterization, with risk of brain stem infarct. The objective was to minimize the risk of cerebral embolization by using percutaneous embolization and TCD monitoring.