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Contemporary presentation and evolution of management of neck paragangliomas.
MedLine Citation:
PMID:  19497493     Owner:  NLM     Status:  In-Process    
BACKGROUND: The aim of the present study was to review the contemporary presentation and evolution of management of neck paragangliomas.
METHODS: Forty-one neck paragangliomas operated on in 36 patients over a 44 year period were included in the current report. The study period was divided into two parts, the first three decades (1964-1989), during which the current management techniques were evolved, and the last two decades (1990-2008).
RESULTS: Patients presented with a palpable neck mass (n = 17), cranial nerve (CN) palsy (n = 3) or both (n = 6), or the lesion was an incidental finding (n = 14). The use of cross-section imaging modalities (n = 24) increased from 35% during the first part of the study to 95% during the second part of the study (P < .001). Preoperative embolization (introduced in 1979) was performed in 60% (median size 4.3 cm for embolized vs 3 cm [P = .02], for non-embolized tumors). During the first study period, the frequency of Shamblin group II/III tumors was 95% compared with a frequency of 42% during the second study period (P < .001, odds ratio 25), median blood loss was 600 ml and 150 ml, respectively (P = .001) and the transfusion rate was 44% and 5%, respectively (P = .008). The incidence of temporary and permanent new CN deficits postoperatively was 22.5% and 10%, respectively, and was similar during the two study periods. Three tumors were malignant, based on lymph node involvement (n = 1) or development of late metastases (n = 2).
CONCLUSIONS: In the modern era, neck paragangliomas can be managed with a low incidence of long-term sequelae. Smaller, asymptomatic, and incidentally detected tumors are currently the most common presentation pattern.
Stavros K Kakkos; Daniel J Reddy; Alexander D Shepard; Judith C Lin; Timothy J Nypaver; Mitchell R Weaver
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter     Volume:  49     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1365-73.e2     Citation Subset:  IM    
Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
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