Neurosurgery Coding Alert

More than 60% of paragangliomas in the head and neck region arise in the carotid bodies.

What are carotid paragangliomas? Carotid paragangliomas are benign vascular tumors that commonly arise in the fourth or fifth decade of life and present as pulsatile painless mass at the angle of the mandible. Carotid body paragangliomas are usually nonfunctioning but occasionally these tumors may secrete histamine, serotonin, epinephrine and norepinephrine.

Diagnosis of carotid paragangliomas: Duplex scan is the tool for most effective diagnosis, but angiography and CT or MRI is helpful to plan surgical management. On imaging, there may be a vascular mass splaying the internal carotid artery posterolaterally and the external carotid artery anteromedially starting from the carotid artery bifurcation. The T1W1 images may show a salt and pepper appearance. The former due to subacute hemorrhages and latter due to flow voids. An angiography may reveal an intense tumor blush between the internal and external carotid arteries. The main feeding branch is usually the ascending pharyngeal artery, a branch of the external carotid artery.