Carotid and vagal body paragangliomas

Area of Science:

• Neuro-oncology
• Head and Neck Surgery
• Vascular Surgery

Background:

• Paragangliomas are rare neuroendocrine tumors originating from neural crest cells.
• Neck paragangliomas, particularly carotid body tumors (CBTs) and vagal paragangliomas, require careful surgical consideration due to proximity to vital neurovascular structures.

Purpose of the Study:

• To evaluate the surgical outcomes and complications associated with the resection of neck paragangliomas.
• To assess the safety and efficacy of preoperative embolization in managing hypervascular CBTs.
• To analyze the incidence and persistence of cranial nerve palsies following surgical intervention.

Main Methods:

• Retrospective analysis of 25 patients with 32 neck paragangliomas (21 CBTs, 4 vagal) treated between 1972 and 2012.
• Surgical resection was the primary treatment modality; preoperative embolization was performed in select hypervascular CBTs.
• Assessment of intraoperative blood loss, perioperative complications (cerebrovascular accidents, death), and postoperative neurological deficits, including cranial nerve palsies.

Main Results:

• Twenty-nine paragangliomas were resected, including three cases involving internal carotid artery resection, without cerebrovascular accidents or perioperative mortality.
• Preoperative embolization in five CBTs did not significantly alter intraoperative blood loss.
• Cranial nerve palsy was present preoperatively in 36% of patients; new postoperative nerve dysfunction occurred in 16%, with persistent deficits in 12%.

Conclusions:

• Surgical resection of neck paragangliomas, including those involving major vessels, can be performed safely with low morbidity and no mortality.
• While preoperative cranial nerve deficits are common, surgical intervention has a manageable rate of new or persistent nerve dysfunction.
• The study supports the safety and efficacy of surgical management for neck paragangliomas, emphasizing the importance of experienced surgical teams.