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Adventitial dissection with advanced vessel-sealing for carotid body paraganglioma: A 2-year recurrence-free case report and technical note

Year: 2025

Type: article

Abstract: INTRODUCTION AND IMPORTANCE: Carotid body paragangliomas present unique surgical challenges due to their hypervascular nature and proximity to critical neurovascular structures. Subadventitial dissection combined with vessel-sealing techniques represents a technical option to achieve complete resection while minimizing complications, though long-term outcome reports remain limited. CASE PRESENTATION: A 52-year-old male presented with a 2-month history of a pulsatile left cervical mass associated with chronic neck pain. Examination revealed classic clinical signs (Kocher's and Fontaine's positive). Imaging demonstrated a 3.5 cm Shamblin I tumor at the carotid bifurcation with with <180° arterial contact (Arya I) and preserved vascular anatomy. Biochemical testing confirmed a non-secreting profile. The patient underwent en bloc resection via subadventitial dissection and vessel-sealing, achieving complete tumor removal without vascular reconstruction or nerve injury. CLINICAL DISCUSSION: This case highlights several key technical considerations in carotid body tumor management. The subadventitial plane provides a dissection barrier, facilitating hemostasis and vascular preservation. Vessel-sealing devices may complement traditional techniques for vascular control. The 2-year recurrence-free outcome supports this approach for selected tumors, though longer follow-up is needed. Cranial nerve preservation highlights the importance of meticulous dissection. CONCLUSION: Subadventitial dissection with vessel-sealing can achieve favorable outcomes in Shamblin I carotid body paragangliomas, enabling complete resection with neurovascular preservation. Further evaluation in larger cohorts is warranted.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111950

Authors: Werda Majd, Amouri Salim, Chaabouni Mohamed Amine, Medhioub Fatma, Charfeddine Ilheme

Institutions: Hopital Universitaire Habib Bourguiba, University of Sfax, Faculty of Medicine of Sfax

Language: English

Topic: Adrenal and Paraganglionic Tumors

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090