External carotid artery ligation in the management of carotid body tumors: A case report

Introduction and importance

Carotid body tumors (CBTs) are rare paragangliomas located at the bifurcation of the carotid artery. These tumors present significant clinical challenges due to their potential for local extension, high vascularity, and proximity to critical neurovascular structures. The rarity of complete resections requiring external carotid artery ligation (ECAL) underscores the clinical significance of this case, highlighting both the technical challenge and the functional outcome.

Case presentation

We report a case of a CBT in a middle-aged patient presenting with a progressively enlarging neck mass. Preoperative angio-CT revealed a 3.5 × 4.5 cm, highly vascularized tumor encasing the carotid bifurcation. Surgical resection was undertaken, during which the tumor was found to completely encase the external carotid artery, making dissection impossible without ligation. ECAL was therefore performed intraoperatively to allow safe mobilization of the tumor and ensure hemostasis.

The postoperative course was favorable, without major complications. The patient developed ipsilateral facial paresthesia, dysphonia, and aspiration episodes during the first postoperative month, likely related to intraoperative nerve manipulation or the ECAL. Aspiration resolved within the first month, while both dysphonia and facial paresthesia gradually improved and fully resolved by six months.

Clinical discussion

Surgical resection of cervical paragangliomas is challenging due to hypervascularity and proximity to cranial nerves. In our case, ECAL provided immediate hemostasis and clarified the ICA–tumor interface, enabling safe resection without compromising cerebral perfusion.

Conclusion

ECA ligation is a safe and effective adjunct in selected complex carotid body tumors, providing reliable vascular control with minimal neurological morbidity. This case supports its utility in complex, high-grade tumors.