title: Management of vagal paragangliomas including application of internal carotid artery stenting.
abstract: BACKGROUND
  The primary treatment of vagal paraganglioma (VP) includes 'wait and scan', surgery and radiotherapy.
  
  
  OBJECTIVE
  To present the clinical findings, surgical treatment including application of internal carotid artery (ICA) stenting to facilitate surgery, and complications, as well as to review the literature and to discuss the decision-making process in the management of VP cases based on our experience and the literature.
  
  
  METHODS
  A retrospective case review of 22 cases with VP.
  
  
  METHODS
  Quaternary neurotologic and skull base referral center.
  
  
  METHODS
  The retrospective chart review identified 22 patients presenting with VP. Our indication for surgery was VP in younger patients, irrespective of the existence of vocal cord paralysis. Preoperative endovascular management of the ICA included permanent balloon occlusion (PBO) and stenting. The transcervical approach and the infratemporal fossa approach type A (ITFA) were used.
  
  
  RESULTS
  Fifteen cases had multicentric paragangliomas, 5 cases bilateral tumors, 3 cases a genetic mutation, and 2 cases a positive family history. The most common symptoms were hoarseness, tinnitus and hearing loss. The surgical approaches commonly employed for excision were the transcervical approach (9 cases) and the ITFA (12 cases), whereas 1 case did not have surgery. Three cases had PBO and 7 had intracarotid stent insertion. Gross total removal was achieved in 19 cases, and 1 case had a recurrence. Eighteen cases had no dysphagia or were well compensated after surgery. There were no significant complications noted in our series.
  
  
  CONCLUSIONS
  In younger patients with VP, surgery should be recommended. The proper preoperative endovascular intervention and surgical approach facilitates gross total tumor removal. In the management of bilateral or familial paragangliomas, careful and appropriate decision making is essential.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, CHA University, Seongnam, Republic of Korea. drshinsh@gmail.com
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Shin
authors.forename: Paolo
authors.initials: P
authors.lastname: Piazza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Donato
authors.forename: Shailendra
authors.initials: S
authors.lastname: Sivalingam
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lauda
authors.forename: Francesca
authors.initials: F
authors.lastname: Vitullo
authors.forename: Mario
authors.initials: M
authors.lastname: Sanna
mesh_terms: D000328:Adult; D002343:Carotid Artery, Internal / Q000601:surgery*; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000601:surgery*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome; D020421:Vagus Nerve Diseases / Q000601:surgery*