Künzel Julian, Koch Michael, Brase Christoph, Fietkau Rainer, Iro Heinrich, Zenk Johannes
Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
Am J Otolaryngol. 2014 Mar-Apr;35(2):186-91. doi: 10.1016/j.amjoto.2013.08.020. Epub 2013 Sep 17.
To analyze the results after surgery or stereotactic radiotherapy (SRT) in the treatment of cervical paragangliomas. Against this background, the decision-making algorithm used in the treatment of carotid body tumors (CBTs) and vagal paragangliomas (VPs) was reevaluated relative to the existing literature on the topic.
Retrospective study between 2000 and 2012. A total of 27 CBTs and nine VPs in 32 patients were treated. Shamblin class I: 59.3% (n=16); class II: 29.6% (n=8); class III: 11.1% (n=3). Treatment modalities were surgery, radiotherapy, or observation. The end points for analysis were long-term tumor control and integrity of the cranial nerves.
21 CBTs and seven VPs underwent surgery; SRT was performed in three CBTs and two VPs. Three CBTs were clinically observed. Permanent nerve paresis followed after surgery for CBTs in five patients (20%) and in all patients with VPs. No impaired cranial nerve function resulted after SRT. The median follow-up period was 4.7 years. The tumor control rate after therapy for CBTs and VPs was 100%. One CBT that received clinical observation showed slow tumor progression.
A surgical procedure should be regarded as the treatment of choice in patients with small CBTs. In larger CBTs, particularly in elderly patients with unimpaired cranial nerves, radical surgery should be regarded critically. As surgery for VPs caused regularly impairment of cranial nerves with functional disturbances of various degrees a comprehensive consultation with the patient is mandatory and nonsurgical strategies should be discussed.
分析手术或立体定向放射治疗（SRT）治疗颈副神经节瘤后的结果。在此背景下，相对于该主题的现有文献，重新评估了用于治疗颈动脉体瘤（CBT）和迷走神经副神经节瘤（VP）的决策算法。
2000年至2012年的回顾性研究。共治疗了32例患者的27个CBT和9个VP。Shamblin I级：59.3%（n = 16）；II级：29.6%（n = 8）；III级：11.1%（n = 3）。治疗方式为手术、放疗或观察。分析的终点是长期肿瘤控制和颅神经完整性。
21个CBT和7个VP接受了手术；3个CBT和2个VP进行了SRT。3个CBT进行了临床观察。5例（20%）CBT患者术后出现永久性神经麻痹，所有VP患者术后均出现永久性神经麻痹。SRT后未出现颅神经功能受损。中位随访期为4.7年。CBT和VP治疗后的肿瘤控制率为100%。1例接受临床观察的CBT显示肿瘤进展缓慢。
对于小型CBT患者，手术应被视为首选治疗方法。对于较大的CBT，特别是颅神经未受损的老年患者，应谨慎考虑根治性手术。由于VP手术经常导致不同程度功能障碍的颅神经损伤，必须与患者进行全面会诊并讨论非手术策略。
