Head and neck paragangliomas (HNPG) are rare, mostly benign neoplasms that usually exhibit an indolent growth pattern although they can be associated with compression and infiltration of adjacent cranial nerves and, depending on the site of origin, also bone and intracranial structures. Less than 5 % of the tumors are considered malignant based on the presence of metastases and not local invasion. Carotid body tumors accounts for two-thirds of HNPG, whereas vagal paragangliomas are showing the highest tendency toward malignant character.Despite the usual treatment of benign tumors is surgery, the risks of the treatment-related complications and potential deterioration of quality of patient's live, however, should not be greater than the risk brought by the tumor in its natural course. Watchful waiting and radiotherapy are widely accepted in the management of vestibular schwannomas, a tumor that is usually indolent but, like HNPG, also has an unpredictable growth pattern. Review of different national tumor registry databases revealed that in the United States there has been a significant shift in management of vestibular schwannomas over a decade, with increasing tendency toward observation and radiotherapy, whereas the proportion of operated cases declined to near a half of the total [1][2][3]. Similar studies on the trends of treatment are lacking in HNPG. Systematic analysis of the literature has shown that most of the HNPG have been treated surgically, with no data on the impact of observation in the management of these tumors [4,5].
''Wait and see'' policyLikewise, due to prevailingly indolent nature HNPG with low growth potential the decision on optimal treatment in HNPG is delicate, even more in view of the facts that tumor growth in individual paraganglioma (PG) case cannot be predicted and mortality caused directly by the tumor is a rare event that occurs in only 1-4 % of patients [4]. According to Jansen et al. [6], the median increase in size in a series of 48 HNPG was 0.83 mm/year. A volume increase of 20 % was noted in 60 % of the tumors, with a median increase in dimension in this subgroup of 1 mm/ year. In addition, tumor doubling time has been universally estimated as low, ranging between 4.2 and 13.8 years for HNPG [7,8].