Outcomes after Surgical Resection of Head and Neck Paragangliomas: A Review of 61 Patients

David M Neskey; Georges Hatoum; Rishi Modh; Francisco Civantos; Fred F Telischi; Simon I Angeli; Donald Weed; Zoukaa Sargi

doi:10.1055/s-0031-1275251

Skull Base 2011; 21(3): 171-176
DOI: 10.1055/s-0031-1275251

ORIGINAL ARTICLE

Outcomes after Surgical Resection of Head and Neck Paragangliomas: A Review of 61 Patients

David M. Neskey¹ , Georges Hatoum² , Rishi Modh³ , Francisco Civantos¹ , Fred F. Telischi¹ , Simon I. Angeli¹ , Donald Weed¹ , Zoukaa Sargi¹

¹Department of Otolaryngology, University of Miami, Miami, Florida
²Department of Radiation Oncology, University of Miami, Miami, Florida
³Department of Miller School of Medicine, University of Miami, Miami, Florida

Abstract

ABSTRACT

We reviewed the postoperative functional outcome following surgical resection of paragangliomas in patients with and without preoperative cranial nerve dysfunction. Patients who underwent surgical resections of head and neck paragangliomas were reviewed with functional outcomes defined as feeding tube and/or tracheostomy dependence, need for vocal cord medialization, and incidence of cerebral vascular accidents as primary end points. Secondary end points included pre- and postoperative function of lower cranial nerves and the impact of this dysfunction on long-term functional status. Sixty-one patients were identified: 27 with carotid paraganglioma (CP), 21 with jugular paraganglioma (JP), 8 with tympanic paragangliomas, 4 with vagal paragangliomas (VPs), and 1 with aortopulmonary paraganglioma. Following resection, 8 patients were feeding tube dependent, 14 patients required vocal cord medialization, 2 patients suffered strokes, but no patients required tracheostomy tubes. Twenty percent of patients (4/20) with JP and postoperative cranial neuropathies were feeding tube dependent, and 80% of patients (4/5) with CP and postoperative cranial nerve dysfunction were feeding tube dependent. Cranial nerve deficits were more common in patients with JP relative to those with CP. However, when cranial nerve dysfunction was present, our patients with CP had a higher incidence of temporary feeding tube dependence. Overall, 98% of patients were able to resume oral nutrition.

KEYWORDS

Paragangliomas - functional outcomes - feeding tube dependence - cranial nerve dysfunction

Volltext

Referenzen

REFERENCES

1 Baysal B E. Hereditary paraganglioma targets diverse paraganglia. J Med Genet. 2002; 39 617-622
2 Glenner G G, Grimley P M. Tumors of the extra-adrenal paraganglion system (including chemoreceptors). In: Atlas of Tumor Pathology. Washington, DC: Armed Forces Institute of Pathology; 1974
3 Thabet M H, Kotob H. Cervical paragangliomas: diagnosis, management and complications. J Laryngol Otol. 2001; 115 467-474
4 Lack E E, Cubilla A L, Woodruff J M. Paragangliomas of the head and neck region. A pathologic study of tumors from 71 patients. Hum Pathol. 1979; 10 191-218
5 Grufferman S, Gillman M W, Pasternak L R, Peterson C L, Young Jr W G. Familial carotid body tumors: case report and epidemiologic review. Cancer. 1980; 46 2116-2122
6 Niemann S, Müller U. Mutations in SDHC cause autosomal dominant paraganglioma, type 3. Nat Genet. 2000; 26 268-270
7 Netterville J L, Jackson C G, Miller F R, Wanamaker J R, Glasscock M E. Vagal paraganglioma: a review of 46 patients treated during a 20-year period. Arch Otolaryngol Head Neck Surg. 1998; 124 1133-1140
8 Druck N S, Spector G J, Ciralsky R H, Ogura J H. Malignant glomus vagale: report of a case and review of the literature. Arch Otolaryngol. 1976; 102 534-536
9 Romanski R. Chemodectoma (non-chromaffinic paraganglioma) of the carotid body with distant metastases; with illustrative case. Am J Pathol. 1954; 30 1-13
10 Erickson D, Kudva Y C, Ebersold M J et al.. Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients. J Clin Endocrinol Metab. 2001; 86 5210-5216
11 van Baars F, Cremers C, van den Broek P, Geerts S, Veldman J. Genetic aspects of nonchromaffin paraganglioma. Hum Genet. 1982; 60 305-309
12 Parry D M, Li F P, Strong L C et al.. Carotid body tumors in humans: genetics and epidemiology. J Natl Cancer Inst. 1982; 68 573-578
13 Patetsios P, Gable D R, Garrett W V et al.. Management of carotid body paragangliomas and review of a 30-year experience. Ann Vasc Surg. 2002; 16 331-338
14 Green Jr J D, Brackmann D E, Nguyen C D, Arriaga M A, Telischi F F, De la Cruz A. Surgical management of previously untreated glomus jugulare tumors. Laryngoscope. 1994; 104 (8 Pt 1) 917-921
15 Biller H F, Lawson W, Som P, Rosenfeld R. Glomus vagale tumors. Ann Otol Rhinol Laryngol. 1989; 98 (1 Pt 1) 21-26
16 Rosenwasser H. Glomus jugulare tumors. I. Historical background. Arch Otolaryngol. 1968; 88 1-40
17 Makek M, Franklin D J, Zhao J C, Fisch U. Neural infiltration of glomus temporale tumors. Am J Otol. 1990; 11 1-5
18 Myssiorek D. Head and neck paragangliomas: an overview. Otolaryngol Clin North Am. 2001; 34 829-836 v
19 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951; 74 491-516

Zoukaa SargiM.D.

Department of Otolaryngology, University of Miami

1475 NW 12th Avenue, Suite 4025, Miami, FL 33136

eMail: zsargi@med.miami.edu