Arts H A, Fagan P A
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
Otolaryngol Head Neck Surg. 1991 Jul;105(1):78-85. doi: 10.1177/019459989110500111.
Six cases of vagal body tumor are reviewed. All first presented as painless neck masses with normal cranial nerve function. Otologic symptoms were infrequent, occurring only with temporal bone involvement. In true vagal paragangliomas, cranial nerve and auditory function is usually preserved until there is extensive disease of the skull base. Tumor progression after radiotherapy was documented in four patients, three of whom were treated with 4500 cGy or more. One patient was found to have regional lymph node metastases. The six patients had a total of 10 head and neck paragangliomas, illustrating the high incidence of synchronous and metachronous lesions. Because of the high incidence of multiple lesions, these tumors threaten lower cranial nerves bilaterally in many instances. Because cranial nerve function is preserved until late, and because vagal and accessory nerve paralysis is usually unavoidable with resection, we advocate conservative treatment in selected cases. It may be reasonable to postpone surgery until cranial nerve impairment becomes evident or other vital structures are threatened.
回顾了6例迷走神经体瘤病例。所有病例最初均表现为无痛性颈部肿块，颅神经功能正常。耳部症状不常见，仅在颞骨受累时出现。在真正的迷走神经副神经节瘤中，颅神经和听觉功能通常得以保留，直到颅底出现广泛病变。4例患者放疗后有肿瘤进展记录，其中3例接受了4500 cGy或更高剂量的放疗。1例患者发现有区域淋巴结转移。这6例患者共有10个头颈部副神经节瘤，说明同步和异时性病变的发生率很高。由于多发病变的发生率很高，这些肿瘤在许多情况下会双侧威胁低位颅神经。由于颅神经功能直到晚期才会受损，并且由于切除迷走神经和副神经通常不可避免地会导致麻痹，我们主张在某些病例中采取保守治疗。推迟手术直到颅神经损害明显或其他重要结构受到威胁可能是合理的。
