Paragangliomas of the Head and Neck

Abstract

Paragangliomas of the head and neck are rare neoplasms that arise from the paraganglia of the chemoreceptor system. The ideal treatment for patients with paraganglioma remains a matter of debate. Treatment options include surgery, endovascular embolization, fractionated radiation therapy, and stereotactic radiosurgery, alone or in combination. The difficulties associated with the surgical treatment of paragangliomas are primarily related to excessive intraoperative bleeding. Fractionated radiation therapy for head and neck paragangliomas is a safe and efficient treatment associated with a high probability of cure and a low incidence of morbidity. Stereotactic radiosurgery has proven to be highly effective in the treatment of paragangliomas and conveys a relatively low risk of complications. The CyberKnife is a frameless radiosurgery system in which an orthogonal pair of X-ray cameras is coupled with a linear accelerator that is dynamically manipulated by a robotic arm with six degrees of freedom. In addition to delivering a highly conformal dose distribution, the treatment of complexly shaped lesions is made more accessible by the system’s non-isocentric geometry. This allows an extremely homogeneous dose delivery. We report the CyberKnife treatment for single-session radiosurgery and the emerging role of multisession radiosurgery for the rare neuropathology of paragangliomas.