Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Audiol Neurotol 2012;17:39–53 DOI: 10.1159/000329213 Management of Vagal Paragangliomas Including Application of Internal Carotid Artery Stenting Seung-Ho Shin   a Paolo Piazza   b Giuseppe De Donato   c Shailendra Sivalingam   d Lorenzo Lauda   c Francesca Vitullo   c Mario Sanna   c   a  Department of Otolaryngology – Head and Neck Surgery, CHA University, Seongnam, Republic of Korea; b  Department of Neuroradiology, University of Parma, Parma, and c  Gruppo Otologico, Casa di Cura, Piacenza/Rome, Italy; d  Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia loss. The surgical approaches commonly employed for exci- sion were the transcervical approach (9 cases) and the ITFA (12 cases), whereas 1 case did not have surgery. Three cases had PBO and 7 had intracarotid stent insertion. Gross total removal was achieved in 19 cases, and 1 case had a recur- rence. Eighteen cases had no dysphagia or were well com- pensated after surgery. There were no significant complica- tions noted in our series. Conclusions: In younger patients with VP, surgery should be recommended. The proper pre- operative endovascular intervention and surgical approach facilitates gross total tumor removal. In the management of bilateral or familial paragangliomas, careful and appropriate decision making is essential. Copyright © 2011 S. Karger AG, Basel Introduction Vagal paragangliomas (VP) are rare neuroendocrine neoplasms that may arise from paraganglia along the course of the vagus nerve and account for approximately 5% of all head and neck paragangliomas, with an annual incidence of 1 per 100000 population [Eriksen et al., 1991; Lawson, 1980; Netterville et al., 1998; Persky et al., 2004; Zanoletti and Mazzoni, 2006]. VP generally present as a slow-growing neck mass which may protrude medially Key Words Chemodectoma  Vagal paraganglioma  Tumors, associated  Internal carotid artery  Stenting Abstract Background: The primary treatment of vagal paraganglio- ma (VP) includes ‘wait and scan’, surgery and radiotherapy. Objectives: To present the clinical findings, surgical treat- ment including application of internal carotid artery (ICA) stenting to facilitate surgery, and complications, as well as to review the literature and to discuss the decision-making pro- cess in the management of VP cases based on our experi- ence and the literature. Design: A retrospective case review of 22 cases with VP. Setting: Quaternary neurotologic and skull base referral center. Material and Methods: The retro- spective chart review identified 22 patients presenting with VP. Our indication for surgery was VP in younger patients, irrespective of the existence of vocal cord paralysis. Preop- erative endovascular management of the ICA included per- manent balloon occlusion (PBO) and stenting. The transcer- vical approach and the infratemporal fossa approach type A (ITFA) were used. Results: Fifteen cases had multicentric paragangliomas, 5 cases bilateral tumors, 3 cases a genetic mutation, and 2 cases a positive family history. The most common symptoms were hoarseness, tinnitus and hearing Received: January 25, 2011 Accepted after revision: March 24, 2011 Published online: June 17, 2011 Neurotology Audiology Dr. Seung-Ho Shin, MD Department of Otolaryngology – Head and Neck Surgery CHA Bundang Medical Center, CHA University 351 Yatap-dong, Bundang-gu, Seongnam 463-712 (Republic of Korea) Tel. +82 31 780 5340, E-Mail drshinsh  @  gmail.com © 2011 S. Karger AG, Basel 1420–3030/12/0171–0039$38.00/0 Accessible online at: www.karger.com/aud