Caldarelli C, Iacconi C, Della Giovampaola C, Iacconi P, Beatrice F
Department of Otorhinolaryngology and Maxillofacial Surgery, ASL 4, Turin, Italy.
Acta Otorhinolaryngol Ital. 2007 Jun;27(3):139-43.
Two uncommon cases of paragangliomas arising from the vagus nerve are described. The first patient underwent surgery for suspected carotid body tumour. In the second patient, computed tomography scan and digital angiography allowed a correct pre-operative diagnosis to be made. These cases confirm the prevalence of vagal paragangliomas in female sex and middle age, and the possibility of multiple similar tumours in the same patient. Histological benign features, absence of neurological symptoms, of local invasion or intracranial extension confirm the frequent benign behaviour of these neoplasms. Lack of catecholamine secretion confirms the low incidence of functioning tumours. Contrast computed tomography and digital angiography still remain the gold standard reliable instruments for diagnosis despite the success of magnetic resonance imaging, magnetic resonance angiography and octreotide scintigraphy to detect head and neck paragangliomas. A transcervical approach, without mandibulotomy, is suitable too for large tumours but complete removal, with sparing of involved segments of the vagus nerve, is rarely possible. Post-operative neurological morbidity is still an unsolved issue and, therefore, rehabilitation of deglutition and phonation is an integral part of management.
本文描述了两例罕见的起源于迷走神经的副神经节瘤病例。首例患者因疑似颈动脉体瘤接受手术。第二例患者通过计算机断层扫描和数字血管造影得以在术前做出正确诊断。这些病例证实了迷走神经副神经节瘤在女性和中年人群中的普遍性，以及同一患者出现多个相似肿瘤的可能性。组织学上的良性特征、无神经症状、无局部侵犯或颅内扩展证实了这些肿瘤通常具有良性行为。缺乏儿茶酚胺分泌证实了功能性肿瘤的低发生率。尽管磁共振成像、磁共振血管造影和奥曲肽闪烁扫描在检测头颈部副神经节瘤方面取得了成功，但对比计算机断层扫描和数字血管造影仍然是可靠的诊断金标准工具。对于大型肿瘤，经颈入路（不进行下颌骨切开术）也是合适的，但很少能够在保留迷走神经受累节段的情况下完全切除肿瘤。术后神经功能障碍仍然是一个未解决的问题，因此，吞咽和发声功能的康复是治疗的一个重要组成部分。
