INTRAVAGAL PARAGANGLIOMAS - REPORT OF 4 CASES

THE INTRAVAGAL PARAGANGLIOMA is a very rare tumor of the head and neck that accounts for only 5 % of the paragangliomas in that area. A pain less mass in the high neck with extension into the peripharyngeal spac e is the most common characteristic of this tumor. Malignant paragangl iomas with invasion of the cervical lymph nodes and carotid artery hav e been reported, but the presence of metastasis, rather than the histo logical findings, is the only parameter for classifying them as malign ant tumors. Despite the numerous descriptions of the efficacy of radia tion therapy, the histological findings of irradiated specimens have s hown little effect of radiation therapy on the chief cells. The only c urative therapy for intravagal paragangliomas is the total resection o f the tumor. Using the supra-adventitia dissection plane, we were able to achieve total resections in four cases of complex intravagal parag anglioma. The surgical management of these cases was complex because o f the following: 1) misdiagnosis as a carotid body tumor, 2) previous radiation therapy and surgical procedure, 3) association with glomus j ugulare, and 4) a giant tumor with invasion of the temporal bone and e ncasement of the internal carotid artery. We report the surgical manag ement of intravagal paragangliomas and the role of radiation therapy, hormonal secretion, and rehabilitation care.