[Angiographic and surgical control of the vertebral and carotid pedicles supplying giant paraganglioma of the skull base and neck].

Results obtained after excision of large jugular paragangliomas are largely conditioned by the possibility of control of the different vascular pedicles, and existing possibilities are discussed in relation to 6 briefly presented cases. The internal carotid artery can either be occluded radiologically by balloon catheter and then embolized if the artery is surrounded by a tumor, or controlled surgically if the artery is in contact with the tumor only and provides only a small proportion of its vascular supply. Whenever internal carotid artery occlusion is envisaged a clamping test by balloon under local anaesthesia is carried out initially. The vertebral artery pedicles are interrupted during surgical approach to the artery above the atlas. The value of a 2 or even 3 stage operation for excision of very large tumors with posterior fossa extension is discussed.