Carotid and vagal body paragangliomas

Abstract

Between 1972 and 2012, 25 patients presenting 32 paragangliomas of the neck were observed. Tumor locations included the carotid body (CBTs) in 21 patients and the vagus nerve in 4. Four patients had bilateral CBT and one a bilateral vagal tumor; a metachronous bilateral jugulare paraganglioma was diagnosed in one patient with bilateral CBT Shamblin type III. Five patients presented CBTs type II and three type III. Preoperative embolization was performed in 5 CBTs, with no significant difference in blood loss. Twenty-nine paragangliomas were resected (with three internal carotid artery resection): there were no cerebrovascular accident or perioperative death. Nine patients (36%) had cranial nerve palsy prior to surgery and a postoperative nerve dysfunction occurred in four other tumors (16%). Persistent nerve deficits occurred in 3 patients (12%). No evidence of malignancy was shown, intraoperatively or during a postoperative follow-up period (9 months to 18 years; mean: 8 years).

Keywords: Carotid body tumor; Vagal paraganglioma.

Fig. 1.

CBT Shamblin type I: caudal-cranial excision (a), and post-resection splayed carotid bifurcation (b). Photograph of excised CBT (c).

Fig. 2.

TC shows bilateral CBT Shamblin type III, surrounding carotid vessels (a). Surgical removal of right tumor (b), with ePTFE interposition graft (c). Photograph of the resected tumor (d). RMI (11 months later) showed right carotid reconstruction and a left CBT with concomitant bilateral jugulare tumor (arrows). Left CBT excision and CyberKnife radiosurgery for jugulare tumors (e).

Fig. 3.

Vagal paraganglioma. MRI showing hypervascular mass dysplaying both ECA and ICA anteriorly (a). Intraoperative photograph of tumor excision (b), with no spreaded carotid bifurcation (c). Photograph of the resected gross specimen shows the mass with no vagal nerve preservation (e).