KBB-Forum 2013 , Cilt 12, Sayı 2

SURGICAL MANAGEMENT OF HEAD AND NECK PARAGANGLIOMAS: REVIEW OF 55 CASES

Gamze ATAY, MD; Rıza Önder GÜNAYDIN, MD; Nilda SÜSLÜ, MD; Serdar ÖZER, MD; Münir Demir BAJIN, MD; Ali Şefik HOŞAL, MD; Levent SENNAROĞLU, MD
Department of Otolaryngology, Hacettepe University Medical School, Ankara, Turkey Objective: The aim of the study is to review a single institution's experience regarding the sites of origin, clinical manifestations and surgical treatment results of head and neck paraganglioms (PGs).

Methods: Fifty one patients who were operated due to head and neck paragangliomas between 2000 and 2012 were included in the study. Retrospective evaluation of the records in means of diagnostic tools, surgical findings and outcomes yielded 55 PGs in 51 patients. Seventeen patients had 20 carotid body tumors (CBT) while 12 had jugulotympanic PG (JTP), 1 had isolated jugular PG (JP), 18 had tympanic PG (TP) and 4 had vagal PG (VP).

Results: CBT: Ballon occlusion test was applied to 10 of 17 excised CBTs. Internal carotid artery was not able to be preserved in 3 patients. No other neurological or vascular deficit was encountered in CBT patients. Complete resection was achieved in all patients. JTP and JP: Preoperative embolization was applied in all JTP's (n=12). Postoperatively, cerebrospinal fluid leakage leading to meningitis was observed in 1 JTP. Complete resection was provided to the JP patient.

TP: Out of 18 patients, 16 were operated through endaural and 2 were through endomeatal incision and complete resection was obtained in all.

VP: Out of 4 VP patients, 3 were undergone balloon occlusion test. Incomplete resection was performed in 1 patient. Cranial nerve palsies were observed in 2 patients postoperatively.

Conclusion: In management of head and neck PGs, choice of treatment modality should be determined according to patient's age, tumor size and location, existence of cranial nerve deficits and experience of the surgeon. For CBTs and TPs, surgery is still the prefferedtreatment of modality in our clinic. In management of VPs, due to possible morbidities, surgery might be reserved until the mass becomes symptomatic. For JTPs, decision of surgery should be individualized. Keywords : Paragangliom, carotid body tumor, jugulotimpanicum, vagal paragangliom