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Multidisciplinary Management of Lateral Skull Base Paragangliomas: A 20-Year Experience.
Eoin F Cleere1, Laura Mc Loughlin1, Orla McArdle2,3
1Department of Otolaryngology Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.
Journal of Neurological Surgery. Part B, Skull Base
|November 1, 2024
Summary
Management of lateral skull base paragangliomas favors upfront treatment for younger, healthier patients with specific genetic mutations or tumor characteristics. Observation and radiotherapy showed a low incidence of new cranial neuropathy in long-term follow-up.
Area of Science:
- Neuroscience
- Oncology
- Otolaryngology
Background:
- Lateral skull base paragangliomas are rare, predominantly benign neuroendocrine tumors.
- Limited evidence exists to guide the clinical management of these tumors.
- Multidisciplinary approaches are crucial for effective patient management.
Purpose of the Study:
- To evaluate considerations in the multidisciplinary workup and management of lateral skull base paragangliomas.
- To identify factors influencing treatment decisions and outcomes.
Main Methods:
- Retrospective review of adult patients with lateral skull base paragangliomas (2002-2021).
- Data collected included patient demographics, tumor characteristics, and treatment strategies.
- Study adhered to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist.
Main Results:
- Seventy patients were analyzed; 81.4% received upfront treatment, while 18.6% underwent active surveillance.
- Younger age, lower American Society of Anesthesiologists (ASA) grade, succinate dehydrogenase (SDH) mutations, and tumor secretion were associated with upfront treatment.
- Fisch A/B tumors, cranial neuropathies, and smaller tumor size predicted surgical resection; observation and radiotherapy showed low rates of new cranial neuropathy.
Conclusions:
- Younger, healthier patients with SDH mutations, cranial neuropathies, or tumor secretion were more likely to receive upfront treatment.
- Active surveillance and radiotherapy demonstrated a low incidence of new cranial neuropathies during long-term follow-up.
- These findings support tailored management strategies for lateral skull base paragangliomas.
