Contemporary presentation and evolution of management of neck paragangliomas.
BACKGROUND
The aim of the present study was to review the contemporary presentation and evolution of management of neck paragangliomas.


METHODS
Forty-one neck paragangliomas operated on in 36 patients over a 44 year period were included in the current report. The study period was divided into two parts, the first three decades (1964-1989), during which the current management techniques were evolved, and the last two decades (1990-2008).


RESULTS
Patients presented with a palpable neck mass (n = 17), cranial nerve (CN) palsy (n = 3) or both (n = 6), or the lesion was an incidental finding (n = 14). The use of cross-section imaging modalities (n = 24) increased from 35% during the first part of the study to 95% during the second part of the study (P < .001). Preoperative embolization (introduced in 1979) was performed in 60% (median size 4.3 cm for embolized vs 3 cm [P = .02], for non-embolized tumors). During the first study period, the frequency of Shamblin group II/III tumors was 95% compared with a frequency of 42% during the second study period (P < .001, odds ratio 25), median blood loss was 600 ml and 150 ml, respectively (P = .001) and the transfusion rate was 44% and 5%, respectively (P = .008). The incidence of temporary and permanent new CN deficits postoperatively was 22.5% and 10%, respectively, and was similar during the two study periods. Three tumors were malignant, based on lymph node involvement (n = 1) or development of late metastases (n = 2).


CONCLUSIONS
In the modern era, neck paragangliomas can be managed with a low incidence of long-term sequelae. Smaller, asymptomatic, and incidentally detected tumors are currently the most common presentation pattern.
Kakkos
Stavros K
SK
Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
Reddy
Daniel J
DJ
Shepard
Alexander D
AD
Lin
Judith C
JC
Nypaver
Timothy J
TJ
Weaver
Mitchell R
MR
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002345:Carotid Body Tumor / Q000601:surgery; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000601:surgery; D020209:Cranial Nerve Injuries / Q000209:etiology; D003390:Cranial Nerve Neoplasms / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D005925:Glomus Jugulare Tumor / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010173:Palpation; D010236:Paraganglioma, Extra-Adrenal / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D020421:Vagus Nerve Diseases / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000009:adverse effects