Skull Base 2006; 16(4): 185-191
DOI: 10.1055/s-2006-950386
ORIGINAL ARTICLE

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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

Malte Kollert1 , Amir A. Minovi1 , Wolfgang Draf1 , Ulrike Bockmühl1
  • 1Department of Otorhinolaryngology, Head and Neck and Facial Plastic Surgery, Hospital Fulda gAG, Teaching Hospital of the Philipps-University Marburg, Fulda, Germany
Further Information

Publication History

Publication Date:
30 August 2006 (online)

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
  • 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
  • 3 Sillars H A, Fagan P A. The management of multiple paragangliomas of the head and neck.  J Laryngol Otol. 1993;  107 538-542
  • 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
  • 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
  • 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
  • 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
  • 8 Biller H F, Lawson W, Som P, Rosenfeld R. Glomus vagale tumors.  Ann Otol Rhinol Laryngol. 1989;  98 21-26
  • 9 Thabet M H, Kotob H. Cervical paragangliomas: diagnosis, management and complications.  J Laryngol Otol. 2001;  115 467-474
  • 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
  • 11 Sniezek J C, Netterville J L, Sabri A N. Vagal paragangliomas.  Otolaryngol Clin North Am. 2001;  34 925-939
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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

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