Carotid stenosis complicating a vagus paraganglioma: A dually rare case

Cervical paragangliomas of the vagus nerve are tumors, of wich the nature and location make them extremely rare, representing only 0.012 % of cervical tumors.

This article reports the case of a 64 year old patient, consulting for a latero-cervical mass associated with dysphonia, dysphagia, and repeated vagal syncopes, evolving for 10 months. The patient underwent surgical resection of the tumor and the carotid artery, with reconstruction by common carotid to internal carotid Polytetrafluoroethylene (PTFE) graft bypass. The patient recovered with no major postoperative complication.

Cervical paragangliomas of the vagus nerve present clinically as a slow-growing latero-cervical mass that damages the cranial pairs, manifesting by dysphonia, dysphagia, vagal syncope and hypertensive peaks. Imaging is a major step in the diagnosis, allowing better planning of the surgical procedure. Magnetic Resonance Imaging (MRI) is considered to be the benchmark imaging for the characterization of the tumor, but Computerised Tomography (CT) Scan, CT angiography and Doppler ultrasonography of Supra-aortic trunks keep an important place in the search of associated vascular lesions. Surgery remains the only curative treatment, but it faces many obstacles, including the difficulty of dissection of the cranial pairs and adjacent vascular structures (especially the carotid artery). The postoperative morbidity is heavy with difficult recovery. The place of radiotherapy is controversial.

Paragangliomas of the vagus in the cervical region are rare tumors, of which the localization is even rarer. Surgical excision remains the only curative treatment. Palliative radiotherapy may be considered for some patients.