Carotid Body Paraganglioma. Diagnosis and Treatment by Angiography

Abstract

Paraganglioma is a rare neoplasia of neural crest origin. It most commonly arises in carotid body, jugular bulb, tympanic plexus on the promontory, and along the vagal nerve pathway or anywhere along the paraganglia pathway. This review describes our experience of cervical paraganglioma. Although there is no consensus in the literature on preoperative angiographic embolization, we think angiography is the gold standard in the diagnosis and treatment of paraganglioma. A small paraganglioma probably does not usually require preoperative embolization because the risks may exceed the benefits. But angiography is mandatory in the diagnosis and treatment of large highly vascular paragangliomas. Imaging of the vascular map of the tumor, that is only possible by angiography, will help the neurosurgeon evaluate the real extension of the neoplasia and chose treatment modalities. Embolization is performed to decrease operative bleeding, shorten the surgery timing and avoid cranial nerve deficit. Cemal Umit Isik et al. studied four brothers with familial paragangliomas noting unexplained concomitant thyroid functional disorders in their patients. Because of the pedigree they thought this may have been a coincidence. Our reported case, unrelated to the Turkish family, also had hypothyroidism suggesting that the relation between paraganglioma and thyroid dysfunction may not be merely a coincidence.