Surgery of the Multifocal Paraganglioma in the head-neck area: not an uncomplicated procedure – a Case Report
23 April 2019 (online)
A Paragangliom is a hypervascular, mostly benign tumor, which occurs along the paarvertebral axis and represents a rare entity with the incidence of 800 new cases in Germany per year. We report on a 53-year-old patient with Multifocal Paraganglioma in the head-neck area.
The initial introduction of the patient took place in the Department of Neurosurgery with a since few weeks intermittently occurring rotatory dizziness. In the diagnostic imaging an osteolytic tumor of the left petrous bone with the spread into the middle ear and into the inner ear canal as well as a destruction of the carotid canal were noticed. Furthermore bilateral cervikal formations, radiologically suspicious for metastases, were described. The resection of the temporal tumor resulted in the histological diagnosis of a benign Paragangliom. Over the time three further Paraganglioma were surgically removed: firstly a tumor in the area of the right carotid artery with an infiltration of CN X and CN XII, secondly a Paraganglioma in the left carotid bifurcation and after a time interval also the cervikal deep-seated vagal tumor on the left side. Postoperatively partial paresis of the involved nerves (right CN XII and both CN's X) gradually occurred, so that in the course of the last surgery after the extubation an inspiratory stridor made a tracheostomy necessary. The clinical inspection showed a bilateral paresis of the vocal cords.
multiple Paraganglioma in the head-neck area represent a surgical challenge. Apart from the intraoperative bleeding risk, relevant lesions of the caudal cranial nerves can occur, despite subtle surgery techniques.