Cervical Paragangliomas-Tumor Control and Long-Term Functional Results after Surgery

 

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ABSTRACT

Objective: To report long-term functional results of the surgical treatment of cervical paragangliomas. Patients and Methods: A retrospective review of 22 patients with 34 head and neck paragangliomas of which 27 were resected between 1981 and 2004. Of these, 16 were carotid body tumors and 11 were vagal paragangliomas. There were 13 women and 9 men with an average age of 48.6 years (range, 26 to 75 years; median, 49 years) and the mean follow-up period was 82 months (range, 3 to 184 months; median, 61 months). Results: There were 13 solitary tumors of which 5 were carotid body tumors and 8 vagal paragangliomas. Multiple head and neck paragangliomas were seen in 9 patients (41%). The incidence of associated multiple tumors was 64.3% for carotid body tumors and 38.5% for vagal paragangliomas. Complete tumor resection was achieved in all but 1 patient in whom a small intradural residual vagal paraganglioma had to be left. The internal carotid artery was preserved in all carotid body tumor resections. Lower cranial nerve deficits were sustained in 1 carotid body tumor resection only, but in all cases with multiple tumors. All patients with vagal paragangliomas had or developed a vagal nerve paralysis. In 4 cases minor complications developed postoperatively. No recurrent tumors were seen during the follow-up period. Conclusions: Even in large head and neck paragangliomas surgical treatment provides excellent tumor control with low postoperative morbidity. A wait-and-scan policy may be more appropriate for those patients with multiple tumors, advanced age, or high operative risk and for those whose tumors have recurred following radiotherapy.

REFERENCES

• 1 Lee J H, Barich F, Karnell L H et al.. American College of Surgeons Commission on Cancer; American Cancer Society. National Cancer Data Base report on malignant paragangliomas of the head and neck.  Cancer. 2002;  94 730-737
  CrossrefPubMedGoogle Scholar
• 2 Lack E E, Cubilla A L, Woodruff J M. Paragangliomas of the head and neck region. A pathologic study of tumours from 71 patients.  Hum Pathol. 1979;  10 191-218
  CrossrefPubMedGoogle Scholar
• 3 Sillars H A, Fagan P A. The management of multiple paragangliomas of the head and neck.  J Laryngol Otol. 1993;  107 538-542
  PubMedGoogle Scholar
• 4 Sobol S M, Dailey J C. Familial multiple cervical paragangliomas: report of a kindred and review of the literature.  Otolaryngol Head Neck Surg. 1990;  102 382-390
  PubMedGoogle Scholar
• 5 Shamblin W R, ReMine W H, Sheps S G, Harrison Jr E G. Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases.  Am J Surg. 1971;  122 732-739
  CrossrefPubMedGoogle Scholar
• 6 van Baars F, van den Broek P, Cremers C, Veldman J. Familial non-chromaffinic paragangliomas (glomus tumors): clinical aspects.  Laryngoscope. 1981;  91 988-996
  PubMedGoogle Scholar
• 7 van Baars F, Cremers C, van den Brock P, Geerts S, Veldman J. Genetic aspects of nonchromaffin paraganglioma.  Hum Genet. 1982;  60 305-309
  CrossrefPubMedGoogle Scholar
• 8 Biller H F, Lawson W, Som P, Rosenfeld R. Glomus vagale tumors.  Ann Otol Rhinol Laryngol. 1989;  98 21-26
  PubMedGoogle Scholar
• 9 Thabet M H, Kotob H. Cervical paragangliomas: diagnosis, management and complications.  J Laryngol Otol. 2001;  115 467-474
  CrossrefPubMedGoogle Scholar
• 10 Urquhart A C, Johnson J T, Myers E N, Schechter G L. Glomus vagale: paraganglioma of the vagus nerve.  Laryngoscope. 1994;  104 440-445
  PubMedGoogle Scholar
• 11 Sniezek J C, Netterville J L, Sabri A N. Vagal paragangliomas.  Otolaryngol Clin North Am. 2001;  34 925-939
  CrossrefPubMedGoogle Scholar
• 12 Köhler H F, Carvalho A L, Mattos Granja N V, Nishinari K, Kowalski L P. Surgical treatment of paragangliomas of the carotid bifurcation: results of 36 patients.  Head Neck. 2004;  26 1058-1063
  CrossrefPubMedGoogle Scholar
• 13 Persky M S, Setton A, Niimi Y, Hartman J, Frank D, Berenstein A. Combined endovascular and surgical treatment of head and neck paragangliomas-a team approach.  Head Neck. 2002;  24 423-431
  CrossrefPubMedGoogle Scholar
• 14 Anand V K, Alemar G O, Sanders T S. Management of the internal carotid artery during carotid body tumour surgery.  Laryngoscope. 1995;  105 231-235
  CrossrefPubMedGoogle Scholar
• 15 Wang S J, Wang M B, Barauskas T M, Calcaterra T C. Surgical management of carotid body tumors.  Otolaryngol Head Neck Surg. 2000;  123 202-206
  CrossrefPubMedGoogle Scholar
• 16 Hinerman R W, Mendenhall W M, Amdur R J, Stringer S P, Antonelli P J, Cassisi N J. Definitive radiotherapy in the management of chemodectomas arising in the temporal bone, carotid body and glomus vagale.  Head Neck. 2001;  23 363-371
  CrossrefPubMedGoogle Scholar
• 17 Cole J M, Beiler D. Long-term results of treatment for glomus jugulare and glomus vagale tumors with radiotherapy.  Laryngoscope. 1994;  04 1461-1465
  PubMedGoogle Scholar
• 18 Evenson L J, Mendenhall W M, Parsons J T, Cassisi N J. Radiotherapy in the management of chemodectomas of the carotid body and glomus vagale.  Head Neck. 1998;  20 609-613
  CrossrefPubMedGoogle Scholar
• 19 Patetsios P, Gable D R, Garrett W V et al.. Management of carotid body paragangliomas and review of a 30-year experience.  Ann Vasc Surg. 2002;  16 331-338
  CrossrefPubMedGoogle Scholar
• 20 Lalwani A K, Jackler R K, Gutin P H. Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor.  Am J Otol. 1993;  14 398-402
  PubMedGoogle Scholar
• 21 Powell S, Peters N, Harmer C. Chemodectoma of the head and neck: results of treatment in 84 patients.  Int J Radiat Oncol Biol Phys. 1992;  22 919-924
  CrossrefPubMedGoogle Scholar
• 22 Netterville J L, Jackson C G, Miller F R, Wanamaker J R, Glasscock M E. Vagal paraganglioma: a review of 46 patients treated during a 20-year period.  Arch Otolaryngol Head Neck Surg. 1998;  124 1133-1140
  CrossrefPubMedGoogle Scholar

Ulrike BockmühlM.D. Ph.D. 

Department of Otorhinolaryngology, Head and Neck and Facial Plastic Surgery, Hospital Fulda gAG, Teaching Hospital of the Philipps-University Marburg

Pacelliallee 4, 36043 Fulda, Germany

Email: u.bockmuehl.hno@klinikum-fulda.de