Antonitsis Polichronis, Saratzis Nikolaos, Velissaris Ioannis, Lazaridis Ioannis, Melas Nikolaos, Ginis Georgios, Giavroglou Constantinos, Kiskinis Dimitrios
A' Surgical Department, Aristotle University of Thessaloniki, G.H. Papageorgiou, Thessaloniki, Greece.
Langenbecks Arch Surg. 2006 Aug;391(4):396-402. doi: 10.1007/s00423-006-0047-3. Epub 2006 May 6.
Cervical paragangliomas are highly vascular neoplasms and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors.
Thirteen patients with 14 paragangliomas were treated in our institution during a period of 15 years. There were eight women (61.5%) and five men (38.5%) with a mean age of 41.3+/-15 years. A painless lateral neck mass was the main finding in 69.2% of patients. There was no evidence of a functional tumor. Carotid angiography was performed in all patients to define the vascular anatomy of the lesion. The 78.6% of paragangliomas underwent selective embolization of the major feeding arteries. Surgical resection followed within the next 48 h.
The majority of the lesions were paragangliomas of the carotid bifurcation (85.7%), while one patient was diagnosed with a jugular and one with a vagal paraganglioma. In one patient, bilateral paragangliomas in the carotid bifurcation were detected. There was no evidence of malignancy in any case. Preoperative embolization has proven successful in reducing tumor vascularity. Vascular reconstruction was necessary in one patient. The main postoperative complication was transient cranial nerve deficit in seven (53.8%) patients, and a permanent Horner's syndrome was documented in one patient. No stroke occurred. The jugular paraganglioma was treated with irradiation due to skull base extension with significant symptomatic relief.
Combined therapeutic approach with preoperative selective embolization followed by surgical resection by an experienced team offers a safe and effective method for complete excision of the tumors with a reduced morbidity rate.
颈部副神经节瘤是血管丰富的肿瘤，在评估所有颈部侧方肿块时均应考虑到。本研究的目的是回顾本机构对这些肿瘤的治疗经验。
15年间，本机构共治疗了13例患者的14个副神经节瘤。其中女性8例（61.5%），男性5例（38.5%），平均年龄41.3±15岁。69.2%的患者主要表现为无痛性颈部侧方肿块。无功能性肿瘤的证据。所有患者均行颈动脉血管造影以明确病变的血管解剖结构。78.6%的副神经节瘤对主要供血动脉进行了选择性栓塞。在接下来的48小时内进行手术切除。
大多数病变为颈动脉分叉处的副神经节瘤（85.7%），1例患者诊断为颈静脉副神经节瘤，1例为迷走神经副神经节瘤。1例患者在颈动脉分叉处发现双侧副神经节瘤。所有病例均无恶性证据。术前栓塞已被证明可成功减少肿瘤血管。1例患者需要进行血管重建。主要术后并发症为7例（53.8%）患者出现短暂性脑神经功能缺损，1例患者记录有永久性霍纳综合征。未发生卒中。颈静脉副神经节瘤因侵犯颅底并伴有明显症状而接受了放疗。
由经验丰富的团队采用术前选择性栓塞后手术切除的联合治疗方法，为完整切除肿瘤提供了一种安全有效的方法，且发病率降低。
