Management of paragangliomas in otolaryngology practice: Review of a 7-year experience

Emin Karaman, Huseyin Isildak, Mehmet Yilmaz, Deniz Tuna Edizer, Metin Ibrahimov, Harun Cansiz, Nazim Korkut, Ozgun Enver

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND AND AIMS: Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. MATERIALS AND METHODS: Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy. RESULTS: Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief. CONCLUSIONS: The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.

Original languageEnglish (US)
Pages (from-to)1294-1297
Number of pages4
JournalJournal of Craniofacial Surgery
Volume20
Issue number4
DOIs
StatePublished - Jul 1 2009

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Paraganglioma
Otolaryngology
Neck
Neoplasms
Blood Vessels
Carotid Body Tumor
Horner Syndrome
Vagus Nerve
Cranial Nerves
Vascular System Injuries
Skull Base
Middle Ear

All Science Journal Classification (ASJC) codes

  • Surgery
  • Otorhinolaryngology

Cite this

Karaman, Emin ; Isildak, Huseyin ; Yilmaz, Mehmet ; Edizer, Deniz Tuna ; Ibrahimov, Metin ; Cansiz, Harun ; Korkut, Nazim ; Enver, Ozgun. / Management of paragangliomas in otolaryngology practice : Review of a 7-year experience. In: Journal of Craniofacial Surgery. 2009 ; Vol. 20, No. 4. pp. 1294-1297.
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title = "Management of paragangliomas in otolaryngology practice: Review of a 7-year experience",
abstract = "BACKGROUND AND AIMS: Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. MATERIALS AND METHODS: Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6{\%}) and 11 men (42.4{\%}) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5{\%}). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100{\%}) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88{\%}) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3{\%}) patients. Two patients were treated with radiotherapy. RESULTS: Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8{\%}]), whereas 6 patients were diagnosed with jugular (22.2{\%}), 1 with a vagal (3.7{\%}), 1 with a tympanic paraganglioma (3.7{\%}), 2 with jugulotympanic paraganglioma (7.4{\%}), and 1 with laryngeal paraganglioma (3.7{\%}). In 1 patient (3.8{\%}), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8{\%}). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88{\%}) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23{\%}) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3{\%}) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6{\%}). Cerebrospinal fluid leak occurred in 1 patient (3.7{\%}). Postoperatively, stroke was occurred in 1 patient (3.7{\%}). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief. CONCLUSIONS: The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.",
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Karaman, E, Isildak, H, Yilmaz, M, Edizer, DT, Ibrahimov, M, Cansiz, H, Korkut, N & Enver, O 2009, 'Management of paragangliomas in otolaryngology practice: Review of a 7-year experience', Journal of Craniofacial Surgery, vol. 20, no. 4, pp. 1294-1297. https://doi.org/10.1097/SCS.0b013e3181ae213b

Management of paragangliomas in otolaryngology practice : Review of a 7-year experience. / Karaman, Emin; Isildak, Huseyin; Yilmaz, Mehmet; Edizer, Deniz Tuna; Ibrahimov, Metin; Cansiz, Harun; Korkut, Nazim; Enver, Ozgun.

In: Journal of Craniofacial Surgery, Vol. 20, No. 4, 01.07.2009, p. 1294-1297.

Research output: Contribution to journalArticle

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AU - Isildak, Huseyin

AU - Yilmaz, Mehmet

AU - Edizer, Deniz Tuna

AU - Ibrahimov, Metin

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AU - Korkut, Nazim

AU - Enver, Ozgun

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N2 - BACKGROUND AND AIMS: Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. MATERIALS AND METHODS: Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy. RESULTS: Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief. CONCLUSIONS: The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.

AB - BACKGROUND AND AIMS: Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. MATERIALS AND METHODS: Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy. RESULTS: Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief. CONCLUSIONS: The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.

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