Incidence and risk factors of cerebral hyper-perfusion syndrome like symptoms after resection of carotid body tumours

Introduction

Cerebral hyper-perfusion syndrome (CHS) is a rare but severe complication after surgery of carotid artery related disease (with a varied incidence range of 0–25.7 %), while its association with carotid body tumour (CBT) surgery is unknown. This study aimed to investigate the incidence and risk factors of CHS-like symptoms after resection of CBTs.

Methods

This retrospective study included 152 CBT patients (165 operated tumours) who received surgery at Peking Union Medical College Hospital from March 2013 to December 2021 and had fully-available clinical records. Surgeries were performed by the several operation teams (around 4–5 teams during the study period) from the department of vascular surgery, of which the team leaders were all senior vascular surgeons who had full experience on CBT surgery. CHS-like symptom was determined based on clinical manifestation and its risk factors were identified by univariate and multivariate regression analyses.

Results

The mean age of this cohort was 44.2 ± 10.9 years and female patients represented 67.1 % (102/152). There were 13 (13/152, 10.5 %) cases receiving bilateral CBT resections, generating a total of 165 operated tumours. The median maximum diameter of the tumours was 3.5 cm (IQR: 2.5–4.8 cm), with 37 (22.4 %), 40 (24.2 %) and 88 (53.3 %) lesions being classified as Shamblin I, II and III, respectively. All CBTs were completely resected under general anaesthesia, with 51 patients undergoing balloon occlusion tests (51/152, 33.6 %) preoperatively and no preoperative embolization was performed. During surgery, 34 cases (34/165, 20.6 %) underwent intervention for internal carotid artery (ICA) and 43 cases (43/165, 26.1 %) underwent external carotid artery ligation. Among the 165 operations, 43 cases developed CHS-like symptoms after surgery (26.1 %, 43/165), of which 26 cases received dehydrant therapy due to severe symptoms (60.5 %, 26/43) and most cases developed symptoms within 48 h after surgery (90.7 %,39/43). Univariate analysis revealed that occurrence of CHS-like symptoms is significantly related with elevated post-operation immediate heart rate (HR) (P = 0.006), post-operation day 1 morning HR (P = 0.004), ICA intervention (P = 0.002) and postoperative new-onset hypertension (P = 0.02). Furthermore, ICA intervention (P = 0.008) and new-onset hypertension (P = 0.017) remained the independent risk factors for development of CHS-like symptoms in multivariate regression analysis.

Conclusion

CBT excision is related to a significant incidence of postoperative CHS-like symptoms, of which intraoperative ICA intervention and post-operative new-onset hypertension are the independent risk factors, thus more attention and closer monitoring should be given on such patients so as to prevent life-threatening CHS-related cerebral complications.