Primary lumbar paraganglioma: A single-centre UK experience over 21 years

Abstract

Abstract Objectives Paragangliomas are rare neuro-endocrine neoplasms which may occur at multiple anatomical sites, typically the adrenal glands. In the CNS, they can affect the head and neck, and more rarely the lumbar region. Primary lumbar paragangliomas are prominently vascularised lesions which can present variably and pose both diagnostic and surgical challenges. Methods We identified and analysed all cases of lumbar paraganglioma confirmed both surgically and histologically, treated at our regional neurosurgical centre. We collected retrospective clinical, radiological, surgical and histological data. Results We treated 25 patients with confirmed paraganglioma between 1997–2018. This included 19 primary tumours, of which 13 cases of primary lumbar paraganglioma (8 males (61.5%); mean age 51.3 years, range 33.2 – 68.9). Patients presented most frequently with a recent worsening of long-standing lower back pain and sciatica. 7 patients were admitted as emergency cases, including 3 with cauda equina syndrome. The average Ki67 mitotic index was 5.7% (range 1 – 10%). Conclusion We present one of the largest case series of primary lumbar paragangliomas to date to the best of our knowledge. Defining these clinical, radiological, surgical and histological features may be of assistance in recognising and managing this surgical disease.