Kollert M, Minovi A, Mangold R, Hendus J, Draf W, Bockmühl U
Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf-, Hals- und Plastische Gesichtschirurgie, Kommunikationsstörungen, Klinikum Fulda gAG, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg.
Laryngorhinootologie. 2006 Sep;85(9):649-56. doi: 10.1055/s-2006-925234. Epub 2006 Apr 10.
Surgical therapy for paragangliomas (PG) of the head and neck is, due to the alternatives of radiation therapy and wait-and-scan strategy and because of postoperative morbidity, under ongoing discussion.
Between 1981 and 2004, 79 patients with 94 PG of the head and neck were treated at our department. These patients had follow-up examination within a clinical trial considering tumor control, functional results and for the first time neuropsychologically evaluated postoperative quality of life. Mean follow-up time was 65 months (1 to 228 months).
Among the 94 PG there were 19 carotid body (GCP), 12 vagal nerve (GVP) and 63 jugular-tympanal paragangliomas (JTP). Of these, 87 tumors underwent surgery. In 68 patients (78.1 %), the tumor could be removed completely. In particular, complete resection of GCP was achieved in 100 %, of GVP in 90.9 %, of JTP type A in 100 %, of JTP type B in 83.3 %, of JTP type C in 66.6 % and of JTP type D in 61.5 %. During the follow-up period, residual or recurrent tumors were diagnosed in 17 patients (19.5 %). Six of the seven residual PG were observed by magnetic resonance tomography and did not show growth. One residual PG and 6 recurrencies were resected completely. One recurrent tumor was radiated and 3 others are under observation without showing growth tendencies. Two patients died postoperatively due to borderline operations of extended tumors. The quality of life after PG surgery showed a SIP of 4.8, which is comparably much better than after acoustic neuroma surgery (SIP 10.3).
Whereas complete tumor resection of GCP and JTP types A and B is almost ever possible without cranial nerve palsies, surgery of GVP and advanced JTP causes often severe functional deficits. However, postoperative quality of life is mostly good. Nevertheless, advanced PG require an individualized therapeutic regime also including radiation and observation of tumor growth.
由于存在放射治疗和等待观察策略等替代方案，且考虑到术后发病率，头颈部副神经节瘤（PG）的外科治疗仍在持续讨论中。
1981年至2004年间，我们科室治疗了79例患有94个头颈部PG的患者。这些患者在一项临床试验中接受了随访检查，评估内容包括肿瘤控制情况、功能结果，并首次对术后生活质量进行了神经心理学评估。平均随访时间为65个月（1至228个月）。
在94例PG中，有19例为颈动脉体瘤（GCP），12例为迷走神经瘤（GVP），63例为颈静脉鼓室副神经节瘤（JTP）。其中，87例肿瘤接受了手术治疗。68例患者（78.1%）的肿瘤得以完全切除。具体而言，GCP的完全切除率为100%，GVP为90.9%，A型JTP为100%，B型JTP为83.3%，C型JTP为66.6%，D型JTP为61.5%。在随访期间，17例患者（19.5%）被诊断出有残留或复发性肿瘤。7例残留PG中有6例通过磁共振断层扫描观察到，且未显示生长。1例残留PG和6例复发性肿瘤被完全切除。1例复发性肿瘤接受了放射治疗，另外3例正在观察中，未显示生长趋势。2例患者因扩大肿瘤的临界手术术后死亡。PG手术后的生活质量显示社会功能缺陷量表（SIP）评分为4.8，这比听神经瘤手术后（SIP为10.3）要好得多。
虽然GCP以及A型和B型JTP几乎总能在不导致颅神经麻痹的情况下实现肿瘤完全切除，但GVP和晚期JTP手术常导致严重的功能缺陷。然而，术后生活质量大多良好。尽管如此，晚期PG需要个体化的治疗方案，也包括放射治疗和观察肿瘤生长情况。
