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Dharamshila Hospital and Research Centre Removes Rare-sized Carotid Body Tumour

Tumour was highly vascular and being supplied by branches of common carotid, internal carotid and external carotid artery

Dr Anshuman Kumar with the patient

Dharamshila Hospital and Research Centre, Delhi gave a new lease of life to 52-year-old lady from Kabul, Afghanistan suffering from carotid body tumour.

"This lady had visited nearly all the hospitals there to get this tumour removed, but no one was ready to take it up. We decided to take this challenge. The whole operation was as challenging as diffusing an atom bomb," says Dr Anshuman Kumar, Consultant Onco-surgeon, Dharamshila Hospital and Research Centre, who conducted this surgery.

Swelling in the neck is not uncommon. There are many more reasons for this stage- from tuberculosis to tumour. When an unusual tumour presents with difficulty in breathing and swallowing, the situation is even worse. This was, however, the rare case with this lady presenting with long history of neck swelling on the right side and recent development of difficulty in breathing and swallowing due to pressure on the upper part of wind and food pipe.

After complete investigation, it was labelled as carotid body tumour arising from the carotid arteries in the neck. This surgery was difficult to conduct because two carotid arteries (one on each side of the neck) supply blood to the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside. Carotid body is an organ at the bifurcation of the common carotid artery and is responsible for maintenance of pulse, blood pressure and respiration through feedback mechanism.

"During surgery, there is always a risk of bradycardia, and hypotension. Tumour was highly vascular and being supplied by branches of common carotid, internal carotid and external carotid artery, therefore, there were high chances of bleeding. During surgery injury to the internal carotid artery may lead to hemiplegia (loss of power in one half of body) and even death," informs Dr Kumar.

Other vital structures like proximity of the tumour to cranial nerves and the vulnerability to injury were saved in the case. In this particular case, the tumour was very big (Shamblin type III) and encroached upon the parapharyngeal space and skull base, again an area of meticulous and delicate approach during surgery.

First of all, vital structures are taken care of -- major blood vessels and all cranial nerves in the viscidity of tumour. "Bipolar cautery was used. It minimises the risk of carotid body stimulation," says Dr Kumar. Meticulous dissection in the subadventitial plane of the carotid vessels took the surgery forward. "Finally, dissection at the skull base and parapharyngeal space was done to remove the tumour," concluded Dr Kumar.

During the operation, there was constant monitoring and maintenance of vital parameters. Post operatively, patient recovered uneventfully and was discharged on the third post-operative day. As of today, she has recovered and is back to Kabul.

Sonal Vij


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