Surgical Management and Outcomes of Carotid Body Tumors in a High-Altitude Region of Yemen: A Prospective Cohort Study

Purpose: Carotid body tumors (CBTs) are more prevalent in high-altitude populations, possibly owing to chronic hypoxia-induced carotid body hyperplasia. This study evaluated the clinical characteristics and surgical outcomes of CBTs at a tertiary center in Sana'a, Yemen, located approximately 2,250 m above sea level. Materials and Methods: This prospective observational study included 24 patients who underwent CBT resection between October 2023 and November 2025 at our institution. We analyzed patient demographics, tumor volume, Shamblin classification, operative details, and surgical outcomes. Factors associated with cranial nerve injury (CNI) were evaluated using Fisher exact and non-parametric tests. Results: The cohort had a mean age of 37.8±11.3 years, with marked female predominance (87.5%) and a high prevalence of blood group O (83.3%). Most tumors were advanced, with Shamblin class II or III tumors accounting for 91.7% of cases. External carotid artery (ECA) management, including permanent ligation in three patients and temporary clamping in one patient, was required in 16.7% of cases. The overall transient CNI rate was 29.2% (7/24), and no permanent neurological deficits or perioperative stroke occurred. Transient CNI was numerically more frequent in patients with Shamblin class III tumors than in those with Class I/II tumors (45.5% vs. 15.4%; P=0.182). Intraoperative ECA management was significantly associated with transient CNI (100.0% vs. 15.0%; P=0.003), whereas tumor volume was not significantly associated with CNI (P=0.820). Conclusion: In this cohort, surgical resection of CBTs in a high-altitude region of Yemen was feasible without preoperative embolization, with no permanent neurologic deficits or perioperative stroke. The observed high prevalence of blood group O may suggest a distinctive demographic feature in this population, although this finding requires further investigation. Shamblin class III tumors showed a numerically higher rate of transient CNI, and the need for ECA management appeared to reflect greater surgical complexity. Long-term follow-up and larger studies are needed to validate these findings.