Head and neck paragangliomas: 30‐year experience

Abstract

Background We aimed to review our experience and the changing trends in the management of head and neck paragangliomas (HNPG) over the last three decades. Methods We retrospectively reviewed 103 patients with HNPG treated at our center (1986‐2017). We included patients treated with surgery, radiotherapy, and patients maintained under active surveillance. Results Of the surgically treated patients (n = 79), 20% (12/59) of the carotid body tumors (CBT) had a cranial nerve deficit as sequela compared to 95% (19/20) of the non‐CBT. Radiotherapy controlled growth in all tumors treated with this modality (n = 10). Of the initially observed patients, 70% (14/20) remained stable and did not require additional treatment. Stratifying by decades, there was a progressive increase in patients initially attempted to be observed and a decrease in upfront surgery. No deaths attributable to the HNPG were encountered. Conclusions Surgery is an effective treatment for CBT. Nonsurgical treatment should be considered for non‐CBT.

Operative management of symptomatic, metachronous carotid body tumors involving the skull base and its neurological sequelae

“…Carotid body tumors (CBTs) are the most common head and neck paragangliomas. 1 This rare pathology arises from the periadventitia of the carotid bifurcation. The carotid body maintains homeostasis of carbon dioxide, oxygen, and pH, while carotid baroreceptors in the carotid sinus regulate blood pressure.…”

“…[5][6][7] Patients most commonly experience deficits of the vagus (6%), hypoglossal (6%), and accessory (3%) nerves as well as the sympathetic chain (3%). 1 Clinical implications include hoarseness, dysphagia, dysgeusia, unilateral neck weakness, and Horner's syndrome. The Shamblin classification classically stratifies the degree of tumor encasement of the carotid arteries in order to predict the need for carotid reconstruction; a higher Shamblin classification is associated with greater risk of cranial nerve injury.…”

“…Its incidence is rare in the setting of bilateral CBTs; two case series (n=306) describe this pathology only twice (<0.01%). 1,13 A described preoperative evaluation of neurovascular insufficiency involves manual compression of the common carotid artery for thirty minutes. 7 In our patient, a multidisciplinary approach assessed adequate cerebrovascular J o u r n a l P r e -p r o o f perfusion with ICA balloon occlusion via a published and standard technique.…”

Results of surgical resection of carotid body tumors: A twenty-year experience

“…[24][25][26][27][28][29][30] However, radiotherapy is used for head and neck paraganglioma when the risk of morbidity from resection is high, particularly in non-CBT paraganglioma. 11,31 Valero et al 31 recently reported treatment outcomes of 103 patients with head and neck paraganglioma (68 with CBTs, 35 with non-CBTs). Stable disease or partial regression was reported in all patients treated with radiotherapy (10/103); dermatitis and mucositis occurred in 40% of these patients.…”

“…12 However, given that rates of cranial nerve deficit from resection significantly increase with tumor size, and reported rates of tumor progression are variable, it has been recommended that CBTs smaller than 5 cm be resected. 12,31 This study was limited by its retrospective nature, small sample size, short follow-up duration, and loss of patients to follow-up.…”