title: Classification and management of cervical paragangliomas.
abstract: BACKGROUND
  Cervical paragangliomas are slow-growing tumours that eventually cause lower cranial nerve palsies and infiltrate the skull base. Surgical treatment may cause the same deficits and, in some, risks more serious neurological deficits. We describe a classification used to  guide investigation, consent and management of cervical paragangliomas based on extensive experience.
  
  
  METHODS
  The case notes of patients managed by the senior author at a tertiary referral skull base unit between 1987 and 2010 were reviewed retrospectively. A total of 87 cervical paragangliomas  were identified in 70 patients (mean age: 46 years, range: 13-77 years). Of these, 35 patients had 36 vagal paragangliomas, 43 patients had 50 carotid body paragangliomas and 8 had both. One cervical paraganglioma arose from neither the carotid body nor the nodose ganglion. The main  outcome measures were death, stroke, gastrostomy and tracheotomy.
  
  
  RESULTS
  All tumours were classified pre-operatively based on their relationship to the carotid artery, skull base and lower cranial nerves. Type 1 tumours were excised with a transcervical approach, type 2 with a transcervical-parotid  approach and type 3 with a combined transcervical-parotid and infratemporal fossa approach. Type 4 patients underwent careful assessment and genetic counselling before any treatment was undertaken. There were no peri-operative deaths; two patients had strokes, one required a long-term feeding  gastrostomy and none required a tracheotomy.
  
  
  CONCLUSIONS
  The use of a pre-operative classification system guides management and surgical approach, improves accuracy of consent, facilitates audit and clarifies which patients should be referred to specialised centres.
authors: Department of Otolaryngology, Guy's hospital, London SE1 9RT, UK. rupertobholzer@nhs.net
authors: R J
authors: RJ
authors: Obholzer
authors: R
authors: R
authors: Hornigold
authors: S
authors: S
authors: Connor
authors: M J
authors: MJ
authors: Gleeson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005157:Facial Pain / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000145:classification* / Q000175:diagnosis / Q000601:surgery; D010243:Paralysis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult