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[Paragangliomas of the head and neck. Part 2: Therapy and follow-up]
J Schipper1, C C Boedeker, W Maier
1Universitätsklinik für Hals-Nasen-Ohren-Heilkunde und Poliklinik des Universitätsklinikum Freiburg. schipper@hno.ukl.uni-freiburg.de
Abstract:
Paragangliomas of the head and neck are preferably treated surgically. Planning the surgical approach for temporal bone paragangliomas is performed according to the Fisch classification. Small temporal paragangliomas can be removed in a transtympanic or transmastoidal procedure. Locally advanced paragangliomas of the head and neck have to be embolized presurgically. An occlusion test is also recommended to check the possibility of a resection of the internal carotid artery. Type C and D temporal bone paragangliomas can be removed by different infratemporal approaches. Alternatively, some type C(1,2 )and De,i(1,2) temporal bone paragangliomas can be removed via variations of the juxtacondylar approach. Glomus caroticum tumors are resected transcervically. In cases of contraindications for surgery or in palliative situations radiotherapy is recommended.
Insights
Surgical resection is the primary treatment for head and neck paragangliomas. Surgical approach for temporal bone paragangliomas is guided by the Fisch classification, with varying techniques for different tumor types and locations.
Area of Science:
- Otolaryngology
- Neurosurgery
- Surgical Oncology
Background:
- Paragangliomas are rare neuroendocrine tumors that can occur in the head and neck.
- Surgical management is the preferred treatment modality for these tumors.
- Accurate surgical planning is crucial for successful outcomes.
Purpose of the Study:
- To outline the surgical strategies for managing head and neck paragangliomas.
- To detail the application of the Fisch classification in temporal bone paraganglioma surgery.
- To describe alternative and palliative treatment options.
Main Methods:
- Surgical resection based on tumor location and extent.
- Classification of temporal bone paragangliomas using the Fisch system.
- Pre-surgical embolization for advanced tumors.
- Occlusion testing for internal carotid artery involvement.
- Radiotherapy for unresectable or palliative cases.
Main Results:
- Transtympanic or transmastoidal approaches for small temporal paragangliomas.
- Infratemporal and juxtacondylar approaches for advanced temporal bone paragangliomas (Type C and D).
- Transcervical resection for glomus caroticum tumors.
- Radiotherapy as an alternative for surgical contraindications or palliative care.
Conclusions:
- Surgical approaches for head and neck paragangliomas are tailored to tumor classification and location.
- The Fisch classification provides a framework for temporal bone paraganglioma surgery.
- Multimodal treatment strategies, including embolization and radiotherapy, are essential for comprehensive management.
