Subtotal Resection for Management of Large Jugular Paragangliomas with Intact Lower Cranial Nerves

Abstract

Objectives: (1) Evaluate the use of subtotal resection as the primary treatment modality for large jugular paragangliomas in patients with intact lower cranial nerves. (2) Evaluate functional outcomes and tumor control following subtotal resection. (3) Identify the utility of salvage radiotherapy for residual progressive disease. Methods: Retrospective series from a tertiary academic referral center evaluating patients who presented with advanced (Glasscock-Jackson grade 3 to 4) jugular paragangliomas (JP) and normal lower cranial nerve function. Primary outcome measures included extent of resection, long-term tumor control, need for additional treatment, and postoperative lower cranial nerve function. Results: Fourteen patients seen between 1999 and 2013 (mean age 48.6 years; range, 26-70) met inclusion criteria. The average maximum preoperative tumor dimension was 3.1 cm. The mean postoperative residual tumor volume was 29.3% (range, 3.5%-58.4%). When the residual tumor volume was less than 20% of the preoperative volume, no tumor growth occurred through an average of 35.4 months of follow-up ( P < .01). Four tumors (28.6%) demonstrated serial growth at an average of 22.5 months following resection, 3 of which were treated with salvage stereotactic radiotherapy providing durable control at an average of 12 months of follow-up. No patient experienced permanent postoperative lower cranial neuropathy. Conclusions: Subtotal resection of JP with preservation of the lower cranial nerves is a viable management strategy. If >80% of the preoperative tumor volume is resected, the residual tumor is less likely to grow. Radiotherapy offers effective treatment for recurrent tumor following subtotal resection.