Prasad Sampath Chandra, Thada Nikhil, Prasad Kishore Chandra
Indian J Otolaryngol Head Neck Surg. 2011 Jan;63(1):62-73. doi: 10.1007/s12070-010-0107-4. Epub 2011 Jan 21.
To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin's Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.
确定头颈部副神经节瘤的临床特征、检查、术中发现、所采用的手术入路及治疗结果。对10年间所见的14例头颈部副神经节瘤进行回顾性研究，其中包括5例颈动脉体瘤、7例颈静脉球瘤和2例鼓室球瘤。所有颈静脉球瘤病例均进行了高分辨率CT扫描和双侧颈动脉血管造影。大多数病例进行了术前栓塞。所有颈动脉体瘤病例均采用经颈入路。3例B型颈静脉球瘤病例采用耳后鼓室切开术。3例D型颈静脉球瘤病例采用 Fisch A型入路。2例鼓室球瘤患者均采用耳后鼓室切开术入路。1例伴有舌下神经麻痹的鼓室外颈静脉球瘤病例，进行颈部探查以分离并切除肿瘤。5例颈动脉体瘤患者表现为颈部上段单侧、无痛性搏动性肿块。术中，3例肿瘤被分类为沙姆林II级，1例为III级，1例为I级。1例II级病变患者发生颈动脉破裂，已得到处理。1例患者不得不进行颈外动脉切除术。7例被诊断为颈静脉球瘤，2例为鼓室球瘤。6例颈静脉球瘤患者表现为听力丧失、耳漏和明显肿胀。鼓室球瘤患者表现为听力丧失，但无耳部出血。检查时，肿瘤表现为耳息肉，无VII神经功能缺损。2例鼓室球瘤均分类为 Fisch A型，3例颈静脉球瘤分类为B型，2例为D2型，1例为D1型。发现肿瘤主要由咽升动脉供血。3例B型颈静脉球瘤病例采用耳后鼓室切开术。3例D型颈静脉球瘤采用 Fisch A型入路。2例鼓室球瘤患者均采用经耳道入路。副神经节瘤是罕见肿瘤，需要准确诊断和熟练的手术技巧。尽管手术入路可能看起来复杂，但切除可提供良好的治愈率，且发病率和复发率极低。侧颅底入路应是每位头颈外科医生的必备手段。
