title: Management of vagal paragangliomas: review of 17 patients.
abstract: Vagal paragangliomas are very rare benign vascular tumors of neuroendocrine nature, and are much less frequent than carotid and jugulo-tympanic tumors. The goal of this retrospective study is to review the clinical and genetic findings, surgical treatment, and complications of vagal paragangliomas, as well as to discuss the management options. During the period 1990-2013, 17 patients with vagal paragangliomas were referred to our institution. There were ten patients with isolated tumors, and seven with multicentric paragangliomas. There were nine women and eight men. Mean age of patients was 51.4 years. Five cases had a positive family history of paraganglioma (29.4 %). Germline mutations of SDH genes were found in six of our patients (35.3 %). Many options were considered in the management of vagal paragangliomas. Surgical treatment was performed in 11 young patients (64.7 %) using different approaches: in 4 patients the tumor was resected through a transcervical approach; in 3 through a transcervical-transmandibular approach; in 1 it was resected using a transcervical-transmastoid approach, and in 3 a type A infratemporal fossa approach was performed. In all operated cases, the removal of the tumor led to sacrificing of the vagus nerve. Postoperative hypoglossal nerve deficit was reported in 4 cases (36.3 %). In six elderly patients (35.3 %), we decided to "wait-and-scan" in order to avoid creating greater morbidity than that of the tumor itself. Many factors should be considered in the treatment of vagal paragangliomas: the age and general condition of the patient, the biological behavior of the tumor, tumor size, genetic results, bilaterality, multicentricity, lower cranial nerve function, and of course the potential morbidity of the surgical treatment itself. Rehabilitation and, possibly surgery, are necessary to treat postoperative lower cranial nerve deficits.
authors: Department of Otolaryngology, Head and Neck Surgery, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo St, 46, 28007, Madrid, Spain, ricardomorujo@hotmail.com.
authors: Ricardo
authors: R
authors: González-Orús Álvarez-Morujo
authors: Miguel
authors: M
authors: Arístegui Ruiz
authors: Carlos
authors: C
authors: Martin Oviedo
authors: Itziar
authors: I
authors: Álvarez Palacios
authors: Bartolomé
authors: B
authors: Scola Yurrita
mesh_terms: D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010236:Paraganglioma, Extra-Adrenal / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D020421:Vagus Nerve Diseases / Q000175:diagnosis* / Q000628:therapy*