Paragangliomas of the head and neck: a contemporary review

Abstract

Head and neck paragangliomas are slow-growing, vascular, typically benign tumors whose growth may induce significant lower cranial nerve deficits. While most tumors arise sporadically, a significant portion are associated with defined genetic syndromes. While surgical resection has historically been the gold standard, management strategies have evolved with acknowledgement of high surgical morbidity, slow tumor growth rates, and technological advances. Conservative management approaches via observation and newer radiation therapy techniques have become more common. This review seeks to provide an update on contemporary management strategies for head and neck paragangliomas and future directions.

The Advantages of Non-Adhesive Gel-like Embolic Materials in the Endovascular Treatment of Benign Hypervascularized Lesions of the Head and Neck

“…It was the adequate total filling of the entire AVM that allowed the complete removal of the hypervascularized formation; only NAGLEMs were able to cope with this task and previous attempts were unsuccessful. An unfilled part of the vascular network leads to the development of collateral blood flow, thereby increasing the risks of surgical complications, and may become a predictor of relapse [16,26]. (An unfilled part of the vascular network of the formation, with insufficient penetration of the embolic agent into the small vessels of the formation, increases the risks of intraoperative complications, and also leads to the development of collateral blood flow, thereby being a predictor of relapse.)…”

“…The process of successful embolization of hypervascularized formations depends on many factors, such as the experience of the surgeon, the somatic status of the patient, a competent anesthesia manual, equipment of the operating room, and, above all, the properties of embolizing agents. Currently, there are no randomized studies comparing various embolizing agents in the treatment of hypervascularized formations of the head and neck; however, reviews and articles have appeared that allow the effect of the properties of agents on the clinical outcome to be assessed [26].…”

Management of a Complex Case of a Recurrent Paraganglioma

“…These deficits notably lead to a decrease in the patients’ quality of life marked by dysphagia, hoarseness, Horner syndrome, and hearing loss resulting in a marked reduction in the patients’ quality of life. 6-13…”

“…These deficits notably lead to a decrease in the patients' quality of life marked by dysphagia, hoarseness, Horner syndrome, and hearing loss resulting in a marked reduction in the patients' quality of life. [6][7][8][9][10][11][12][13] Traditionally, surgical extirpation has been the standard of care for managing paragangliomas. However, due to the remarkable vascularity of these tumors and proximity to 21S neurovascular structures, surgical extirpation carries significant risks such as blood loss, speech and swallowing dysfunction, and increased risk of stroke, all of which negatively impact a patient's quality of life.…”

Multi-Disciplinary Approach to Skull Base Paragangliomas

“…Paragangliomas are slow-growing, benign-acting, neuroendocrine neoplasms that develop from the embryonic neural crest. In the vicinity of the skull base, these tumors can develop from cells in the adventitia of the jugular bulb (jugular paraganglioma, glomus jugulare), middle ear (tympanic paraganglioma, glomus tympanicum), or along one of the three ganglia of the vagus nerve (vagal paraganglioma) [3,4]. Patients with temporal bone paragangliomas (jugular or tympanic paraganglioma) commonly present with hearing loss and pulsatile tinnitus [5][6][7][8][9].…”