A paraganglioma is a tumor which develops from a paraganglion and is most of the time benign.
A 50-year old woman presented with the suspicion of an infratemporal paraganglioma on the right-hand side. In April 2018 a paraganglioma on the left neck was extirpated elsewhere. The preoperative proceeded MRI of head and neck showed already the tumor on the right side. The second, right located tumor reached from 4 cm up the carotid artery bifurcation to the subcranial plane. The internal carotid artery was displaced by the tumor. There was no clinical affection of the cranial nerves. Because of the extension of the tumor, a combined interventional-radiological and surgical procedure was planned. Preoperative the embolisation of the arterial inlet of the paraganglioma took place. It was the right hypoglossal nerve which was intraoperative considered as the origin of the paraganglioma. The vagal nerve was additionally infiltrated. By protection of the internal carotid artery both the hypoglossal and the right vagal nerve had to be removed to resect the tumor completely. The pathologic examination confirmed a paraganglioma. As a matter of principle the histological examination on its own cannot judge the dignity – only the proof of metastasis can be seen as a definite malignant aspect. Therefore we decided to add a Ga68-DOTATOC-PET-CT which showed no metastasis. Due to the synchronous appearance of bilateral paraganglioma a non-hereditary paraganglioma syndrome had to be ruled out. Therefore a genetic examination of the SDH gene was ordered.
The functional deficits of the hypoglossal and the vagal nerve resulting in dysphagia and dysarthria were rehabilitated with regularly logopedic therapy
