gms | German Medical Science

Vagal paragangliomas (VP) represent less than 5% of all head and neck paragangliomas. These arise from the paraganglia adjacent to the nodose ganglion of the vagus nerve (CN X).

We report on 8 cases treated during 1997-2005. The F to M ratio was 1,7 to 1. Age ranged from 20 to 66 years. There was history of familial paraganglioma in 2 and multiplicity in 1 patient. The most common presenting symptom was neck mass (75%) and/or bulging oropharyngeal mass (40%), followed by otalgia, tinnitus and uncontrolable hypertension (10%). 1 patient was diagnosed asympomatic. Neither patient presented with dysphonia nor paresis of any CNs. Symptomatology varied from 1 month to 15 years.

75% of patients had CT and 25% MRI. AG was done in 6 patients which was connected with embolization in 25%. This influenced blood loss and operating time.

All patients underwent surgical resection (6 transcervical and 2 mandibulotomy approaches). SND was part of all the operations. In 1 case ECA to ICA anastomosis was done. Sparing of CN X was possible in 75%.

All VP were radically removed. 1 case was malignant with neck lymph node metastases and the patient underwent postoperative radiation. There was not possible to spare any function of CN X. 1 patient had postoperative deficit of CN XII. There were no other CNs deficits. Despite ECA to ICA anastomosis patient suffered from cerebrovascular accident and died. All other patients are dissease free.

Treatment of VP represent a multidisciplinary task. There is no urgency in surgical treatment due to the slow growth, expected morbidity as other anticipiated risks. For elderly and bilateral cases observation or radiation may be the propper choice. But surgery is the only choice to rule out rare malignant cases.