Introduction:
A Paragangliom is a hypervascular, mostly benign tumor, which occurs along the paarvertebral
axis and represents a rare entity with the incidence of 800 new cases in Germany per
year. We report on a 53-year-old patient with Multifocal Paraganglioma in the head-neck
area.
Case Report:
The initial introduction of the patient took place in the Department of Neurosurgery
with a since few weeks intermittently occurring rotatory dizziness. In the diagnostic
imaging an osteolytic tumor of the left petrous bone with the spread into the middle
ear and into the inner ear canal as well as a destruction of the carotid canal were
noticed. Furthermore bilateral cervikal formations, radiologically suspicious for
metastases, were described. The resection of the temporal tumor resulted in the histological
diagnosis of a benign Paragangliom. Over the time three further Paraganglioma were
surgically removed: firstly a tumor in the area of the right carotid artery with an
infiltration of CN X and CN XII, secondly a Paraganglioma in the left carotid bifurcation
and after a time interval also the cervikal deep-seated vagal tumor on the left side.
Postoperatively partial paresis of the involved nerves (right CN XII and both CN's
X) gradually occurred, so that in the course of the last surgery after the extubation
an inspiratory stridor made a tracheostomy necessary. The clinical inspection showed
a bilateral paresis of the vocal cords.
Conclusion:
multiple Paraganglioma in the head-neck area represent a surgical challenge. Apart
from the intraoperative bleeding risk, relevant lesions of the caudal cranial nerves
can occur, despite subtle surgery techniques.
