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Active surveillance management of head and neck paragangliomas: case series and review of the literature

  • L Harrison (a1) and R Corbridge (a2)

Head and neck paragangliomas are rare. They are usually slow-growing, benign, non-catecholamine secreting tumours, traditionally treated with surgical excision. Complications of surgical excision include lower cranial nerve palsies, stroke and death.


A retrospective case note analysis was conducted of patients with head and neck paragangliomas treated with a watch-and-scan policy from March 2003 to September 2015, and the relevant literature was reviewed.


Fifteen head and neck paragangliomas were identified. None of the patients developed a new lower cranial nerve palsy or progression of their presenting hearing loss during the follow-up period. Five patients displayed an increase in maximum linear dimension of 4 mm over an average of 57.4 months. A review of the literature showed that a watch-and-surveillance scan policy is evolving as a treatment option for head and neck paragangliomas without malignant risk factors.


Readily available surveillance scanning in head and neck paragangliomas enables the monitoring of head and neck paragangliomas, which may allow for avoidance of major surgery.

Corresponding author
Address for correspondence: Ms Laura Harrison, Department of ENT, Head and Neck Surgery, Northampton General Hospital, Northampton, UK E-mail:
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1 Sykes, JM, Ossoff, RH. Paragangliomas of the head and neck. Otolaryngol Clin North Am 1986;19:755–67
2 Van den Berg, R. Imaging and management of head and neck paragangliomas. Eur Radiol 2005;15:1310–18
3 Havekes, B, Corssmit, EP, Jansen, JC, van der Mey, AG, Vriends, AH, Romijn, JA et al. Malignant paragangliomas associated with mutations in the succinate dehydrogenase D gene. J Clin Endocrinol Metab 2007;92:1245–8
4 Boedeker, CC, Neumann, HP, Maier, W, Bausch, B, Schipper, J, Ridder, GJ. Malignant head and neck paragangliomas in SDHB mutation carriers. Otolaryngol Head Neck Surg 2007;137:126–9
5 Patetsios, P, Gable, DR, Garrett, WW, Lamont, JP, Kuhn, JA, Shutze, WP et al. Management of carotid body paragangliomas and review of a 30-year experience. Ann Vasc Surg 2002;16:331–8
6 Chapman, DB, Lippert, D, Geer, CP, Edwards, HD, Russell, GB, Rees, CJ et al. Clinical, histopathologic, and radiographic indicators of malignancy in head and neck paragangliomas. Otolaryngol Head Neck Surg 2010;143:531–7
7 Samji, KB, Crown, AL, Buxton-Thomas, MS, Aylwin, SJ, Schulte, KM, Dizdarevic, S. Necessity for long-term follow-up of patients with head and neck paraganglioma and mutation in the succinate dehydrogenase genes: an index case report and literature review. Endocr Pract 2012;18:e1304
8 Obholzer, RJ, Hornigold, R, Connor, S, Gleeson, MJ. Classification and management of cervical paragangliomas. Ann R Coll Surg Engl 2011;93:596602
9 Netterville, JL, Jackson, CG, Miller, FR, Wanamaker, JR, Glasscock, ME. Vagal paraganglioma: a review of 46 patients treated during a 20-year period. Arch Otolaryngol Head Neck Surg 1998;124:1133–40
10 Jackson, CG. Glomus tympanicum and glomus jugulare tumours. Otolaryngol Clin North Am 2001;34:941–70
11 Krych, AJ, Foote, RL, Brown, PD, Garces, YI, Link, MJ. Long-term results of irradiation for paraganglioma. Int J Radiat Oncol Biol Phys 2006;65:1063–6
12 Kunzel, J, de Tristan, J, Mantsopoulos, K, Koch, M, Baussmerth, M, Zenk, J et al. Experiences in the treatment of patients with multiple head and neck paragangliomas. Am J Otolaryngol 2014;35:294–9
13 Carlson, ML, Sweeney, AD, Wanna, GB, Netterville, JL, Haynes, DS. Natural history of glomus jugulare: a review of 16 tumours managed with primary observation. Otolaryngol Head Neck Surg 2015;152:98105
14 Langerman, A, Athavale, SM, Rangarajan, SV, Sinard, RJ, Netterville, JL. Natural history of cervical paragangliomas: outcomes of observation of 43 patients. Arch Otolaryngol Head Neck Surg 2012;138:341–5
15 Cosetti, M, Linstrom, C, Alexiades, G, Tessema, B, Parisier, S. Glomus tumors in patients of advanced age: a conservative approach. Laryngoscope 2008;18:270–4
16 Jansen, JC, van der Berg, R, Kuiper, A, van der Mey, AG, Zwinderman, AH, Cornelisse, CJ. Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal. Cancer 2000;15:2811–16
17 Lack, EE, Cubilla, AL, Woodruff, JM, Farr, HW. Paragangliomas of the head and neck region: a clinical study of 69 patients. Cancer 1977;39:397409
18 Van Duinen, N, Steenvoorden, D, Kema, IP, Jansen, JC, Vriends, AH, Bayley, JP et al. Increased urinary extraction of 3-methoxytyramine in patients with head and neck paragangliomas. J Clin Endocrinol Metab 2010;95:209–14
19 Saldana, MJ, Salem, LE, Travezan, R. High altitude hypoxia and chemodectomas. Hum Pathol 1973;4:251–63
20 van der Mey, AG, Maaswinkel-Mooy, PD, Cornelisse, CJ, Schmidt, PH, van de Kamp, JJ. Genomic imprinting in hereditary glomus tumours: evidence for new genetic theory. Lancet 1989;2:1291–4
21 Baysal, BE. Hereditary paraganglioma targets diverse paraganglia. J Med Genet 2002;39:617–22
22 Burnichon, N, Abermil, N, Buffet, A, Favier, J, Gimenez-Roqueplo, AP. The genetics of paragangliomas. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:315–18
23 Jackson, CG, McGrew, BM, Forest, JA, Netterville, JL, Hampf, CF, Glasscock, ME 3rd. Lateral skull base surgery for glomus tumors: long-term control. Otol Neurotol 2001;22:377–82
24 Heath, D. The human carotid body in health and disease. J Pathol 1991;164:18
25 Corssmit, EP, Romijn, JA. Clinical management of paragangliomas. Eur J Endocrinol 2014;171:R23143
26 Taieb, D, Kaliski, A, Boedeker, CC, Martucci, V, Fojo, T, Adler, JR Jr et al. Current approaches and recent developments in the management of head and neck paragangliomas. Endocr Rev 2014;35:795819
27 van den Berg, R, Verbist, BM, Mertens, BJ, van der Mey, AG, van Buchem, MA. Head and neck paragangliomas: improved tumour detection using contrast-enhanced 3D time of flight MR angiography as compared with fat-suppressed MR imaging techniques. Am J Neuroradiol 2004;25:863–70
28 Neskey, DM, Hatoum, G, Modh, R, Civantos, F, Telischi, FF, Angeli, SI et al. Outcomes after surgical resection of head and neck paragangliomas: a review of 61 patients. Skull Base 2011;21:171–6
29 Fish, J, Klein-Weigel, MD, Biebl, M, Janecke, A, Tauscher, T, Fraedrich, G. Systematic screening and treatment evaluation of hereditary neck paragangliomas. Head Neck 2007;29:864–73
30 de Flines, J, Jansen, J, Elders, R, Siemers, M, Vriends, A, Hes, F et al. Normal life expectancy for paraganglioma patients: a 50-year-old cohort revisited. Skull Base 2011;21:385–8
31 Piazza, P, Di Lella, F, Bacciu, A, Di Trapani, G, Ait Mimoune, H, Sanna, M. Preoperative protective stenting of the internal carotid artery in the management of complex head and neck paragangliomas: long-term results. Audiol Neurootol 2015;18:345–52
32 Sethi, RS, Sethi, RK, Herr, MW, Deschler, DG. Malignant head and neck paragangliomas: treatment efficacy and prognostic indicators. Am J Otolaryngol 2013;34:431–8
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  • EISSN: 1748-5460
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