Cervical paragangliomas: neurovascular surgical risk and therapeutic management

Abstract

Paragangliomas of the neck region arise most commonly in the carotid and vagal bodies. The goal of this retrospective study is to evaluate intraoperative vascular and neurological morbidity and to define the therapeutic strategy. During the period 1990-2004, 32 patients with 42 neck paragangliomas were referred to our institution (Head and Neck Service, Otolaryngology Federation, CHU La Timone, Marseilles, France). There were 29 carotid body tumors and 11 vagal body tumors. There were 14 men and 18 women. Forty paragangliomas were surgically excised. Mean age of patients with family history of paragangliomas was 34 years and that of patients without any familial history was 47 years. Only one patient had a malignant paraganglioma. A vascular repair procedure was performed in 10% and always occurred in carotid body tumors including the malignant one. Postoperative hypoglossal nerve deficit was reported in five cases (12.5%). Paralysis of vagus nerve was reported in 11 cases (27.5%), nine of whom were patients with vagal body tumors. Knowledge of number of paragangliomas and their location is of main importance and influences the therapeutic strategy. The goal of this strategy is to avoid major neurovascular morbidity and to optimize treatment of multiple or bilateral tumors. Early management of patients prevents progressive neurological deficit due to an enlarging tumor mass and minimizes neurovascular complications.

Contemporary presentation and evolution of management of neck paragangliomas

“…A multidisciplinary approach is recommended, 20,22,34,50 which may explain the better outcomes achieved in academic centers. 47 Such an approach does require a number of specialists, including radiologists to provide detailed preoperative imaging and perform preoperative tumor embolization when necessary.…”

The management of head-and-neck paragangliomas

“…Overall, gross total resection (GTR) is achievable in 90-97% of the cases with a low surgical mortality rate (0-2.7%). However, surgery is associated with haemorrhagic, cerebrovascular and neurological risks (paresis of lower CN leading to swallowing and speech problems, aspiration, feeding tube or tracheostomy dependence, facial palsy and hearing loss; Erickson et al 2001, Kollert et al 2006, Paris et al 2006, Sevilla Garcia et al 2007, Papaspyrou et al 2009, Neskey et al 2011, Obholzer et al 2011. Adjuvant procedures to improve swallowing or hoarseness (e.g.…”

A Carotid Body Tumor Mimicking a Thyroid Nodule

“…PGLs are rare tumors derived from extra-adrenal paraganglionic system, which consist of cells from the neural crest associated with autonomous nervous system [6,7]. PGLs are seen at many sites in head and neck areas, including carotid body, jugular-tympanic region and vagus nerve [7,8].…”

“…PGLs are seen at many sites in head and neck areas, including carotid body, jugular-tympanic region and vagus nerve [7,8]. Unlike pheochromocytomas, PGLs in head and neck regions are usually non-functioning tumors.…”

“…In literature, PGLs are generally reported as slowly growing neck masses without pain [7,18]. Rarely, they may attain large size and infiltrative growth, and the local recurrence of PGLs may lead to death.…”