Management of jugular paragangliomas in otolaryngology practice

Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity and should be considered in the evaluation of all lateral neck masses. The aim of this study was to review an institutional experience in the management of jugular paragangliomas. Thirteen jugular paragangliomas (Fisch classifications C and D glomus jugulare) were treated in our institution during a period of 5 years (2003-2008). All patients with adequate follow-up and complete records (13 cases) were reviewed with emphasis on the results of surgical management and the factors influencing them. Coupled with the residual tumors in 2 patients, the surgical control achieved was 82%. No recurrence was seen. All patients were subjected to digital subtraction angiography to define the vascular supply of the tumor. Microcoil embolization of 11 jugular paragangliomas (all [100%] of the patients who accepted the operation) was performed during the initial digital subtraction angiography. There was no perioperative mortality. There was one case of perioperative cerebrospinal fluid leak, which was repaired during the surgery. The facial nerve was preserved in all of the patients. The overall preservation rate of lower cranial nerves was 54% (7 of 13). Two patients with residual jugular paraganglioma were posttreated with irradiation (gamma knife) owing to skull base extension with significant symptomatic relief. Two patients who refused the surgical treatment were managed by stereotactic radiosurgery. The primary therapeutic option for jugular paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. The combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and effective method for complete excision of tumors with a reduced morbidity rate. Irradiation (gamma knife) is an effective therapy method for residual jugular paraganglioma.