Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model

Li, Lifeng; Xu, Hui; Chen, Xiaohong; Yu, Zhenya; Zhou, Jing; Mydlarz, Wojciech K.; London, Nyall R.

doi:10.1177/01455613211009441

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Head and neck paragangliomas are a rare group of tumors, representing a small percentage of all neoplasms that occur in this part of the body; therefore, they constantly pose a challenge to every surgeon who has to deal with them, especially those who are in close contact with large vessels and cranial nerves, and for their resection has a high risk of devastating complications [18].…”

Section: Discussionmentioning

confidence: 99%

“…Imaging, such as enhanced CT, MRI, ultrasound, and angiography, are the best modalities used to describe the tumor, localization, size, and involvement of essential vessels [12]. Threedimensional modelling represents a unique alternative in describing anatomical challenges and critical neurovascular structures, thereby providing a more comprehensive evaluation of the tumoral invasions or structures that are in close contact with the tumor [18]. When distinguishing between paragangliomas and other tumors, Ga-68 DOTATATE PET/CT proved reliable.…”

Section: Discussionmentioning

confidence: 99%

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Laryngeal Paraganglioma—A Case Report

Palade,

Severin,

Vrinceanu

et al. 2024

Medicina

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Background and Objectives: Paragangliomas of the head and neck are rare neuroendocrine tumors originating from the paraganglia, which might be sympathetic or parasympathetic. Laryngeal paragangliomas are the rarest subtype of these tumors, with only 1.41% of all paragangliomas, arising from the supraglottic or subglottic paraganglia of the larynx. The vast majority of them are benign, but there are some cases in which they turn out to be malignant, and the only way to know with certainty the difference between them is when we identify distant metastases. The aim of this article is to share our experience with a rare case of laryngeal paraganglioma and review the clinical characteristics, methods of diagnostic, necessary investigation prior to the operation, and surgical management of this type of tumor. Materials and Methods: We present the case of a 68-year-old female patient, a non-smoker, who accused dysphagia, dysphonia, foreign body sensation, chronic cough, and hoarseness for six months. We performed a tracheostomy prior to biopsy to secure the airways in case of bleeding and then took a few biopsy samples. The histopathological exam revealed the presence of a laryngeal paraganglioma. An enhanced CT scan was performed in order to describe the localization, size, and invasion of the tumor. We also measured the vanillylmandelic acid from the urine to determine if the tumor produced catecholamines alongside a full cardiology and endocrinology examinations. In order to prevent massive bleeding during the operation, chemoembolization was attempted before surgery, but it was unsuccessful due to an anatomical variation of the left superior thyroid artery. She underwent surgery, first through transoral endoscopic microsurgery; however, we decided to undertake an external approach because of poor bleeding control, even though we had ligated both the superior thyroid artery and the external carotid artery, with a thyrotomy and laryngofissure achieving the complete resection of the tumor. Results: The patient was discharged 10 postoperative days later, with the recommendation of introducing food step-by-step from liquids to solids. She was decannulated after 30 days, with no complications regarding breathing, phonation, or deglutition. Twelve months after the surgery, we did not identify any local relapses of distant metastases. Conclusions: Laryngeal paragangliomas are rare neuroendocrine tumors that arise from the laryngeal paraganglia. Surgery is the best treatment option available, and it can be done by either an external approach or by transoral endoscopy. Enhanced CT or MRI, as well as full cardiological and endocrinological evaluation are mandatory prior to the operation. Measuring the catecholamines levels show the if the tumor is secretory. Controlling the bleeding poses the biggest challenge in performing the resection of the tumor, especially when a transoral endoscopic approach is chosen. Further standardized follow-up guidelines are required in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laryngeal Paraganglioma—A Case Report

Palade,

Severin,

Vrinceanu

et al. 2024

Medicina

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“…A 3D-reconstruction might come in handy for patients with multiple paragangliomas, as it offers a better understanding of the relationships between the tumors and the nerves and vessels, reducing the chances of postoperative complications [ 93 ].…”

Section: Management Of Multicentric Paragangliomasmentioning

confidence: 99%

Paragangliomas of the Head and Neck: A Review of the Latest Diagnostic and Treatment Methods

Palade,

Hainarosie,

Zamfir

et al. 2024

Medicina

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Background and objectives: Paragangliomas of the head and neck are rare, slow-growing neuroendocrine tumors, benign in their vast majority, but with a possibility of developing distant metastases. They show great inheritable character, and their behavior has proven to be unpredictable; therefore, they are considered malignant. Material and methods: This article aims to offer a more comprehensive presentation of the pathogenesis, epidemiology, diagnostic methods, imaging development, and treatment guidelines. We tried to bring together all the necessary data that, in our opinion, a head and neck practitioner should know when managing this type of tumor. Our main focus is on the most recent studies, with the purpose of a homogenous presentation of all current guidelines and approaches to this pathology. Results: Paragangliomas of the head and neck are still a disputed topic. One of the main reasons for that is their low incidence of 0.3 to 1 per 100.000 every year. The most frequent locations are the carotid body, the temporal bone, the jugular and mastoid foramen, and the vagal nerve. Their clinical presentation usually involves a painless lateral mass associated with symptoms such as hoarseness, hearing loss, tinnitus, and cranial nerve deficits. Up to 40% of them are inherited, mostly linked with mutations of succinate dehydrogenase complex. Imaging evaluation consists of CT and MRI, and new functional explorations such as 18F-FDA and 18F-FDG PET/CT, 18F-DOPA PET, 123I-MIBG, and 68Ga-DOTATE PET/CT. Measuring the catecholamine levels in the plasma and urine is mandatory, even though paragangliomas of the head and neck rarely display secretory behavior. Treatment mainly consists of surgery, with different approaches and techniques, but conservative management methods such as wait and scan, radiotherapy, proton therapy, and chemotherapy have proven their efficiency. The therapeutical decision lacks consensus, and current studies tend to recommend an individualized approach. Guidelines regarding long-term follow-up are still a matter of debate.

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