Management of bilateral head and neck paragangliomas at a single-institution across four decades

Head Neck. 2025 Jan;47(1):386-393. doi: 10.1002/hed.27923. Epub 2024 Aug 21.

Abstract

Background: Bilateral head and neck paragangliomas (HNPGLs) require nuanced management to balance tumor control with functional preservation.

Methods: All patients seen at a single-institution for bilateral paraganglioma between 1983 and 2023 were retrospectively reviewed. Demographics, genetic testing results, and tumor characteristics were analyzed and compared to treatment modality and cranial nerve outcomes.

Results: There were 49 patients with 116 tumors (90 carotid body tumors [CBTs], 15 vagal paragangliomas [VPs], and 11 jugular paragangliomas [JPs]). Twenty-six patients had SDH pathologic variants (PV). Surgical management was more commonly utilized in younger patients (OR: 0.97, 95% CI: 0.950-0.992) and for JPs (OR: 9, 95% CI: 1.386-58.443). In surgical cases, CBTs had a lower risk of postoperative cranial nerve deficits compared to JPs and VPs (OR: 0.095, 95% CI: 0.013-0.692).

Conclusions: Younger patients with bilateral HNPGLs, especially those with JP and CBT, are more often treated with surgery. CBTs have lowest risk of cranial nerve deficits after surgery.

Keywords: SDH; bilateral paraganglioma; carotid body tumor; jugular paraganglioma; vagal paraganglioma.

MeSH terms

  • Adult
  • Aged
  • Carotid Body Tumor / pathology
  • Carotid Body Tumor / surgery
  • Female
  • Head and Neck Neoplasms* / pathology
  • Head and Neck Neoplasms* / surgery
  • Head and Neck Neoplasms* / therapy
  • Humans
  • Male
  • Middle Aged
  • Paraganglioma / pathology
  • Paraganglioma / surgery
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult