Development and validation of an improved classification and risk stratification system for carotid body tumors: a multinational collaborative cohort study

Hisham Mehanna*, Pankaj Mistry, Pawel Golusinski, Pasquale Di Maio, Paul Nankivell, Francesco Snider, Angela M.R. Ferrante, Nausica Montalto, Piero Nicolai, Alessandra Marcantoni, Cesare Grandi, Marco Zavatta, Franco Grego, Kataryna Malec, Sefik Hosal, Nilda Suslu, Oguz Kuscu, Ignacio Torrealba, Francisco Valdes, Neil SharmaJohn Ayuk, Peter Monksfield, Richard Irving, Janet A. Dunn, Mark Kay, Daniele Borsetto

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: This study aims to develop and validate a new classification system that better predicts combined risk of neurological and neurovascular complications following CBT surgery, crucial for treatment decision-making.

Methods: Multinational retrospective cohort study with 199 consecutive cases. A cohort of 132 CBT cases was used to develop the new classification. To undertake external validation, assessment was made between the actual complication rate and predicted risk by the model on an independent cohort (n = 67).

Results: Univariate analyses showed statistically significant associations between developing a complication and the following factors: craniocaudal dimension, volume, Shamblin classification, and Mehanna types. In the multivariate prognostic model, only Mehanna type remained as a significant risk predictor. The risk of developing complications increases with increasing Mehanna type.

Conclusions: We have developed and then validated a new classification and risk stratification system for CBTs, which demonstrated better prognostic power for the risk of developing neurovascular complications after surgery.

Original languageEnglish
Pages (from-to)3448-3458
JournalHead and Neck
Issue number11
Early online date21 Aug 2021
Publication statusPublished - Nov 2021

Bibliographical note

Funding Information:
Professor Mehanna is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care. Professor Mehanna is funded by the National Institute for Health Research (NIHR). The study sponsor(s) made no contribution to study design, collection, analysis, and interpretation of data; writing of the report; or the decision to submit the paper for publication.

Publisher Copyright:
© 2021 Wiley Periodicals LLC.


  • carotid body tumor
  • classification
  • paraganglioma
  • Shamblin
  • surgery

ASJC Scopus subject areas

  • Otorhinolaryngology


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