Arterial and venous paragangliomas: the value of a preoperative pacemaker and a multidisciplinary approach

Non-chromaffin paragangliomas are very rare tumours. They arise from chemoreceptor cells at multiple sites throughout the body. They are usually very vascular and most arise in intimate contact with vital structures making their excision a surgical challenge. We describe in this paper four cases of paragangliomas in the carotid body and the jugular bulb. Their presentation was unusual. Two cases underwent excisional surgery and two had radiation treatment because they were not fit for surgery. We had to use a temporary pacemaker for preoperative preparation of the carotid body because of an associated hypersensitive carotid sinus syndrome. The clinical presentation and the surgical management will be described in this paper.