This document summarizes a study of 13 cases of cervical paraganglioma in adolescent patients treated at the National Cancer Institute in Cairo, Egypt. Cervical paragangliomas are rare neuroendocrine tumors that most commonly present as carotid body tumors. The study aimed to review the surgical treatment and functional outcomes of adolescent patients. All 13 patients, with a mean age of 17 years, underwent successful surgical resection of their tumors. The most common tumor was a carotid body tumor. Post-operative complications included difficulty swallowing in 3 patients and temporary cranial nerve deficits, but there was no mortality or vascular injuries reported. The conclusion was that expert surgical resection is the best treatment for cervical paragangliomas in adolescents

1. MANAGEMENT OF
ADOLESCENT CERVICAL
PARAGANGLIOMA: 13
CASES
FOUAD A.FOUAD
Assistant professor of surgical oncology
National Cancer Institute (NCI)
Cairo University
12/27/2013
Fouad Abdelshaheed [NCI]
1

2. INTRODUCTION
• A paraganglioma is a rare neuroendocrine
tumor.
• 75% of paragangliomas are sporadic.
• 25% are hereditary .
• 90% adrenal (pheochromocytoma).
• 10% extra-adrenal .
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3. INTRODUCTION
• Extra-adrenal
– 85% abdomen
– 12% thorax
– 3% head and neck:
•
•
•
•
Carotid body most common(CBT)
Vagal(VP)
Jugulotympanic(JP;TP)
Other
• Cervical paragangliomas [CP] generally
present in mid-adult life.
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4. TREATMENT
• The different therapeutic options include:
Surgical resection.
 Conventional radiotherapy .
 Stereotactic radio surgery
In selected cases a „wait and scan‟ Foote RL,
et al.[2002]
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5. AIM OF THIS STUDY
• The aim to review our experience at NCI in
management of cervical paraganglioma in
the adolescent age as regard:
 Surgical treatment
Functional results.
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6. MATERIAL AND METHODS
• During the period 2002–2011, thirteen
patients with cervical paragangliomas have
been presented to NCI, Cairo university for
surgical treatment.
• All patients were adolescents with mean
age 17.2 years (range, 13 to 21 years).
• Complete surgical resection was possible in
all cases in this study
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7. PREOPERATIVE DATA
Item
No; of the patients
Percentage
Female/male
11/2
84.6%:15.4%
Mean Age(Years)
17.2 2.3
Main symptom:
Lateral neck mass
Mixed symtomatology
Headache
Lt. /Rt.
9/13
3/13
1/13
9:4
69.2%
23%
7.6%
69.2%:30.8%
Duration of symptoms (mean in 15.1 9.4
months)
Size of the tumor
2 cm
2-4cm
>4 cm
3/13
7/13
3/13
23%
53.1%
23%
Pre op. biopsy
2/13
15.3%
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8. Accidental pre-operative biopsy
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10. Pre-operative investigation
• Ultrasonography (US)
In all
• Computerized tomography (CT)
• Magnetic Resonance Imaging (MRI)
[seven out of 13 (53.8%) ]
• Digital subtraction angiography (DSA) {All
cases}
• Balloon test occlusion (BTO) [three cases with
large tumors more than 4 cm]
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cases

11. CP-IMAGING
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12. CP-IMAGING
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13. CP-IMAGING
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14. CP-IMAGING
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15. CP-IMAGING
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16. CP-IMAGING
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18. CP-IMAGING
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19. CP-IMAGING
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20. Preoperative selective
embolization
• Remains a matter of debate as major
complications such as cerebrovascular
accidents might occur.
• For some authors, allows safer surgical
excision of the paraganglioma
• In our series, no patient underwent
selective embolization
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21. OPERATIVE TECHNIQUE
• Incision along the
anterior border of the
sternocleidomastoid
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22. OPERATIVE TECHNIQUE
• Proximal exposure of the CCA.
• The branches from the ECA were ligated
and divided near the tumor border .
• The dissection was performed in the
relatively a vascular subadventitial plane
between the artery and the tumor called
“white line”.
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23. OPERATIVE TECHNIQUE
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24. POST OPERATIVE SPECIMEN
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25. OPERATIVE TECHNIQUE
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26. POST OPERATIVE SPECIMEN
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27. OPERATIVE TECHNIQUE
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28. OPERATIVE TECHNIQUE
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29. POST OPERATIVE SPECIMEN
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30. OPERATIVE DATA
• The mean operative time was 84.7 ±36.4
ml minutes;
• Mean blood loss was 98.07±39 ml.
• Mean size of the resected tumors was
3.6±1.5 cm (range 1.8–6.8 cm).
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31. POST-OPERATVE
DIAGNOSIS
Type of the tumor
Number
Percentage
CBT
Shamblin 1971 class:
8
61.7%
VP
2 [25%]
5 [62.5]
1 [12.5%]
3
23%
JP
2
15.3%
•I [Localized]
•II [Adherent Partially ]
•III [Encasing]
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32. Vascular and neurological
injuries
Item
Cranial nerves injuries
ECA
injury
CBPs
Carotid
arteries
injuries
ICA
injury
IX
3(23%)
1(7.6%)
X
XII
2(15%)
VPs
1(7.6%)
JPs
2(15.3%)
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3(23%)
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1(7.6%)
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33. MORBIDITY AND
MORTALITY
• Post operative difficulty in deglutition in 3
patients.
• No transient ischemic attack or stroke was
noticed in any patient .
• No perioperative mortality was
documented
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34. CONCLUSION
• Cervical paragangliomas in the adolescent
age are a rare entity
• More predominant in females
• Carotid body tumors are the most common
head and neck CP in adolescent age.
• Best treated by proper surgical resection.
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35. CONCLUSION
• Early management of patients and expert
surgeons minimize neurovascular
complications
• Cranial nerve deficits were more common
in patients with JP and VP relative to those
with CBT but all improved rapidly in that
young age.
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