The surface of the tumor is seen posterior to the reflected internal iliac artery. It was clear at this point that this was a neural tumor rather than a carotid body tumor and the case was continued by the neurosurgical team.
The glossopharyngeal, hypoglossal and vagus nerves as well as the cervical sympathetic chain are closely associated with the internal carotid artery. The hypoglossal normally crosses the carotid vessels about 2cm cephalad to the bifurcation. The vagus nerve lies between the carotid arteries and the internal jugular vein. The glossopharyngeal nerve lies deep to the distal internal carotid artery. The cervical sympathetic chain lies embedded in the posterior fibers of the carotid sheath.
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