Vagal paragangliomas: a report of nine cases

Vagal paragangliomas are rare tumors of neural crest origin: fewer than 175 cases have been reported in the English literature. This slow-growing tumor occurs most often at the base of the skull in the parapharyngeal space, but may arise anywhere along the course of the vagus nerve and its branches. Nine clinical presentations and the surgical outcome in seven patients with vagal paragangliomas treated at our institution are reported. A review of the literature, emphasizing evaluation and treatment of these potentially fatal neoplasms, is discussed. Surgical removal is the treatment of choice with vagal tumors. Complications related to the ablation or injury of cranial nerves IX, X, XI, and XII are commonly seen. Surgical techniques that may prevent injury to these vital neural structures are outlined. The postoperative treatment of patients with impaired deglutition secondary to multiple cranial neuropathies is discussed.