Imaging and management of head and neck paragangliomas

Abstract

Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). Diagnostic imaging can be considered in two clinical situations: (1) patients who present with clinical symptoms suggestive of a paraganglioma, and (2) individuals from families with hereditary paragangliomas. It is not only necessary to detect and characterize the lesion, but also to study the presence of multiplicity. For these purposes, MR imaging, and especially 3D TOF MRA, is the modality of choice. CT scanning is especially useful to show destruction of the temporal bone. Angiography in combination with embolization will mainly be used prior to surgical resection, but can also be used for diagnostic purposes when the diagnosis is not yet clear. Many parameters play a role in the decision to treat of which multifocality and impairment of cranial nerves are the most important. The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Resection however, should be balanced against a more conservative "wait and scan" policy or palliative treatments such as radiotherapy.

Role of ultrasound and color Doppler imaging in the detection of carotid paragangliomas

“…In general, the combination of these morphological imaging methods provides sufficient information about the nature and extension of the lesion allowing a correct diagnosis of neck PGL [17] without submitting the patient to cytologic analysis which does often not provide additional information, may lead to vascular complications and diagnostic errors [22]. The role of contrast enhanced US (CEUS) in the initial diagnosis and classification of malignant masses requires further testing [23].…”

Internal carotid artery ligation for excision of a huge Carotid Body Tumor – Report of a Case –

“…In diagnosis, the most useful imaging techniques to identify CBPs and planning surgery remain CTA and MRI 6) . Angiography can be used in cases where the diagnosis is unclear and selective embolization of feeding arteries exists as a therapeutic option 7) . Needle biopsy to confirm diagnosis should be avoided because high vascularity of the lesion can cause disastrous complications.…”

Anaesthetic challenges in carotid body tumour resection: a case report and review of literature

“…8 Though slow-growing and benign, they can invade/exert pressure on neighbouring neurovascular tissues. 9 5-7% may be malignant. 10 History of uncontrolled/recently diagnosed hypertension, tachycardia, flushing and excessive sweating suggests a catecholamine-secreting CBT.…”