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Carotid body tumor resection and baroreflex failure (blood pressure problems)

last modified on: Thu, 10/05/2023 - 09:14

see: Carotid Body and Carotid Sinus - General Information

Introduction

  • Baroreceptors sense systemic changes in blood pressure and adjust sympathetic tone accordingly to regulate excessive fluctuations
  • The primary baroreceptors in humans are located in the carotid sinus
  • Failure of the baroreceptor reflex can be caused by central lesions to the brainstem, trauma that causes loss of innervation of the baroreceptor, tumor that interferes with innervation, or surgical removal (carotid body resection) (Netterville et al. 1995).
  • Loss of innervation of baroreceptor leads to unopposed sympathetic activity and release of catecholamines

Symptoms of baroreflex failure

  • Sudden hypertension (often > 200 mm Hg systolic)
  • Rapidly fluctuating blood pressure

Baroreflex failure after carotid body tumor resection

  • Usually occurs after bilateral carotid body tumor excision (De Toma et al, 2000)
  • The majority of cases occur within a few days post-op but there are reports of baroreflex failure occurring weeks later (Maturo and Brennan, 2006)

Treatment (Heusser et al, 2005)

  • Education of patient and family is key
  • Clonidine and α-methyl-DOPA both inhibit sympathetic activity and attenuate BP volatility
  • Major side effects are sedation and depression
  • Alternative therapies are alpha- and beta- blockers which may not be as effective

Carotid sinus syndrome

  • Carotid sinus syndrome is essentially the opposite of baroreflex failure
  • Hypotension and syncopal episodes occur due to inadvertant triggering of the carotid sinus
  • Carotid massage triggers the carotid sinus pathway (increased pressure on carotid sinus due to massage → sends signal to decrease systemic BP)

References

De Toma, G., Nicolanti, V., Plocco, M., Cavallaro, G., Letizia, C., Piccirillo, G., & Cavallaro, A. (2000). Baroreflex failure syndrome after bilateral excision of carotid body tumors: an underestimated problem. Journal of vascular surgery,31(4), 806-810.

Maturo, S., & Brennan, J. (2006). Baroreflex failure: a rare complication of carotid paraganglioma surgery. The Laryngoscope, 116(5), 829-830.

Heusser, K., Tank, J., Luft, F. C., & Jordan, J. (2005). Baroreflex failure.Hypertension, 45(5), 834-839.

Netterville JL, Reilly KM, Robertson D, Reiber ME, Armstrong WB, Childs P. Carotid body tumors: a review of 30 patients with 46 tumors. Laryngoscope. 1995 Feb;105(2):115-26. doi: 10.1288/00005537-199502000-00002. PMID: 8544589.