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Classification and management of cervical paragangliomas.
R J Obholzer1, R Hornigold, S Connor
1Department of Otolaryngology, Guy's hospital, London SE1 9RT, UK. rupertobholzer@nhs.net
Annals of the Royal College of Surgeons of England
|November 2, 2011
Summary
A new classification system for cervical paragangliomas aids in surgical planning and patient management. This system helps guide investigations, consent, and treatment for these slow-growing tumors.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Cervical paragangliomas are slow-growing tumors impacting cranial nerves and skull base.
- Surgical intervention carries risks of neurological deficits.
Purpose of the Study:
- To introduce a classification system for cervical paragangliomas.
- To guide investigation, consent, and management of these tumors.
Main Methods:
- Retrospective review of 87 cervical paragangliomas in 70 patients (1987-2010).
- Tumor classification based on location relative to carotid artery, skull base, and cranial nerves.
- Outcomes measured included mortality, stroke, gastrostomy, and tracheotomy.
Main Results:
- Tumors classified into Types 1-4, dictating surgical approach (transcervical, transcervical-parotid, combined).
- Type 4 tumors required genetic counseling.
- No peri-operative deaths; low rates of stroke and gastrostomy; no tracheotomies.
Conclusions:
- Pre-operative classification system improves surgical approach accuracy.
- Enhances patient consent, audit, and referral to specialized centers.
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