Question

How will you manage a 42-year-old male with CBT?

Hint:

Surgical resection is the preferred treatment for CBTs, but it requires meticulous planning to avoid damage to the carotid artery and nerves. In some cases, radiation therapy may be used as an adjunct or alternative.

Answer 1

Step 1: Surgical Management:
The mainstay of treatment for CBT is surgical resection. Given the proximity of the tumour to the carotid artery and important cranial nerves, surgical management requires careful planning and expertise. The goal of surgery is to remove the tumour while preserving the carotid artery and surrounding nerves as much as possible. Preoperative imaging is essential to assess the tumour’s size, relationship to surrounding structures, and vascular supply. - Surgical Approach: The approach is typically through a lateral cervical incision to access the carotid bifurcation. The tumour is carefully dissected from the carotid artery and surrounding structures. In some cases, the carotid artery may require temporary clamping during tumour removal.
Step 2: Preoperative Considerations:
Before surgery, the patient should undergo a full preoperative evaluation. This includes controlling comorbidities such as hypertension and diabetes, as well as ensuring that any anticoagulant therapy is appropriately managed. Blood pressure control is particularly important to minimize the risk of intraoperative bleeding.
Step 3: Postoperative Care:
Postoperatively, patients should be closely monitored for complications such as bleeding, infection, or nerve injury. Carotid artery patency should be assessed, and patients should be monitored for any signs of cranial nerve deficits. The use of compression stockings or anticoagulation may also be indicated depending on the patient's risk profile.