Angiographical Investigation of Vagal and Carotid Body Paragangliomas

Although vagal paragangliomas (VPs) and carotid body paragangliomas (CBPs) are both neck paragangliomas, they have different surgical risks and clinical courses. In this report, we investigated the feeding arteries of VPs compared with CBPs, with an aim to better differentiate these tumors and improve our understanding of their angioarchitecture.

We conducted a retrospective analysis of angiography data from 3 cases of VPs and 10 tumors from 9 cases of CBP. For each case, we evaluated the level of the vertebral body corresponding to the upper margin of the tumor, the tumor size, the arterial supply of the tumor, the topological relationship between the external carotid artery and internal carotid artery and the tumor, the details of preoperative embolization, and the incidence of postoperative neurological deficits.

In all 3 cases of VPs, the blood supply originated from the occipital, vertebral, and ascending pharyngeal arteries. By contrast, among the 10 CBP tumors, 3 were supplied by the occipital artery, 1 was supplied by the vertebral artery, and all 10 were fed by the ascending pharyngeal artery. VPs, when compared to CBPs, exhibited larger tumor sizes, a higher positioning of the upper margin of the tumor, and a lack of splaying of the internal and external carotid arteries, compressing both forward. Additionally, preoperative embolization was frequently performed in cases of VPs. Furthermore, the postoperative occurrence of complications such as hoarseness and vocal cord paralysis was also higher.

VPs originate from the inferior ganglion of the vagus nerve, which is chiefly nourished by the vertebral artery. This original arterial distribution may explain the angioarchitecture observed in this study. This study may facilitate the better understanding of the VP angioarchitecture and safe and efficient embolization for them.