title: Contemporary presentation and evolution of management of neck paragangliomas.
abstract: 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.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Stavros K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Reddy
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Shepard
authors.forename: Judith C
authors.initials: JC
authors.lastname: Lin
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Nypaver
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Weaver
mesh_terms: 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