Carotid Paraganglioma. Experience of a Reference Center, UMAE Hospital De Especialidades Del Centro Medico Nacional "La Raza", 964 Cases in 32 Years

Objective: Present our experience as a tertiary referral center in the surgical management of the carotid paraganglioma. Introduction: Carotid paraganglioma is a slow-growing tumor, originated at the chemoreceptor cells of the carotid bulb and due to factors as chronic hypoxia, familiar history or female gender it can present hyperplasia. Most of these tumors are benign and asymptomatic which delays its diagnosis and treatment. Surgical excision is the gold standard treatment. Methods: We performed an ambispective study from 1987 to 2019 of the patients with the diagnosis of carotid paraganglioma that underwent surgical excision in our center, using the Shamblin classification system to describe them. Results: A total of 964 tumors were resected from patients of 21 to 82 years old, in 32 years, with an average of 30 procedures each year. 92% of the patients were female, Shamblin type I 7%, type II 47% and type III 46%; bleeding went from 50 to 10,000 ml, with previous embolization in 8 cases, usage of stent-graft in 10 patients, 6 with external carotid artery ligation and only 1 patient with bypass using PTFE (Polytetrafluoroethylene) graft. Morbidity and mortality: cerebral vascular event in 3%, bleeding >2000 ml in 11%, nerve injury in 23%, vascular injury in 25% and overall mortality 2%. Conclusion: In our center experience, surgical removal is the first treatment of choice; there is no benefit from using other therapies such as embolization, usage of stent-graft in the external carotid artery and only certain chosen patients could benefit from radiotherapy. Malignancy is less than 1%, severe neurological complications in about 3%. Genetic factor in our population, associated with the area height can be determinant.