title: Subtotal resection for management of large jugular paragangliomas with functional lower cranial nerves.
abstract: OBJECTIVE
  To evaluate tumor control following subtotal resection of advanced jugular paragangliomas in patients with functional lower cranial nerves and to investigate the utility of salvage radiotherapy for residual progressive disease.
  
  
  METHODS
  Case series with planned chart review.
  
  
  METHODS
  Tertiary academic referral center.
  
  
  METHODS
  Patients who presented with advanced jugular paragangliomas and functional lower cranial nerves were analyzed. Primary outcome measures included extent of resection, long-term tumor control, need for additional treatment, and postoperative lower cranial nerve function.
  
  
  RESULTS
  Twelve patients (mean age, 46.2 years; 7 women, 58.3%) who met inclusion criteria were evaluated between 1999 and 2013. The mean postoperative residual tumor volume was 27.7% (range, 3.5%-75.0%) of the preoperative volume. When the residual tumor volume was less than 20% of the preoperative volume, no tumor growth occurred over an average of 44.6 months of follow-up (P < .01). Four tumors (33.3%) demonstrated serial growth at a mean of 23.5 months following resection, 2 of which were treated with salvage stereotactic radiotherapy providing control through the last recorded follow-up. No patient experienced permanent postoperative lower cranial neuropathy as a result of surgery.
  
  
  CONCLUSIONS
  Subtotal resection of jugular paragangliomas with preservation of the lower cranial nerves is a viable management strategy. If more than 80% of the preoperative tumor volume is resected, the residual tumor seems less likely to grow.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA george.wanna@vanderbilt.edu.
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Sweeney
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Latuska
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rivas
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Bennett
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Netterville
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Haynes
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005925:Glomus Jugulare Tumor / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: glomus jugulare; jugular paraganglioma; pulsatile tinnitus; subtotal resection