title: Solitary paraganglioma of the hypoglossal nerve: case report.
abstract: BACKGROUND
  We report the case history of solitary hypoglossal paraganglioma in a 64-year-old woman. The surgical difficulties encountered in the removal of this challenging tumor are discussed and as a literature review provided.
  
  
  METHODS
  A 64-year-old woman presented with a short history of dysphonia, occasional dysphagia, tinnitus, altered taste, and unilateral left-sided tongue wasting. On examination, there was left lower motor hypoglossal paralysis. Imaging showed a discrete enhancing lobulated mass, measuring 2 × 2 cm, in the region of the hypoglossal nerve extending into the hypoglossal canal suggestive of hypoglossal paraganglioma. A left dorsolateral suboccipital craniotomy was performed with the patient in the sitting position. The hypoglossal nerve appeared to be enlarged, and the jugular foramen was normal. Complete surgical debulking of the tumor was not attempted because of its vascular nature. The nerve was decompressed, and neuropathology confirmed a low-grade paraganglioma arising from the hypoglossal nerve. The patient was scheduled to receive stereotactic radiation for further management.
  
  
  CONCLUSIONS
  When a case of solitary hypoglossal paraganglioma is encountered in clinical practice, the aim of management should be mainly focused on achieving a diagnosis and preserving the hypoglossal nerve function. If there is evidence of vascularity in the lesion noted on magnetic resonance imaging, a preoperative angiogram should be obtained with a view for embolization. We decompressed the hypoglossal canal and achieved good improvement in the patient's symptoms. We recommend stereotactic radiosurgery for remnant and small hypoglossal tumors and regular follow-up with magnetic resonance imaging scans.
authors.affiliation: Department of Neurosurgery, National Centre for Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland.
authors.forename: Kazim
authors.initials: K
authors.lastname: Raza
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Kaliaperumal
authors.forename: Michael
authors.initials: M
authors.lastname: Farrell
authors.forename: John A
authors.initials: JA
authors.lastname: O'Dwyer
authors.forename: Christopher
authors.initials: C
authors.lastname: Pidgeon
mesh_terms: D003390:Cranial Nerve Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D010235:Paraganglioma / Q000175:diagnosis* / Q000601:surgery; D016634:Radiosurgery