Subtotal Resection for Management of Large Jugular Paragangliomas with Functional Lower Cranial Nerves

ObjectivesTo evaluate tumor control following subtotal resection of advanced jugular paragangliomas in patients with functional lower cranial nerves and to investigate the utility of salvage radiotherapy for residual progressive disease.Study DesignCase series with planned chart review.SettingTertiary academic referral center.Subjects and MethodsPatients who presented with advanced jugular paragangliomas and functional lower cranial nerves were analyzed. Primary outcome measures included extent of resection, long‐term tumor control, need for additional treatment, and postoperative lower cranial nerve function.ResultsTwelve patients (mean age, 46.2 years; 7 women, 58.3%) who met inclusion criteria were evaluated between 1999 and 2013. The mean postoperative residual tumor volume was 27.7% (range, 3.5%‐75.0%) of the preoperative volume. When the residual tumor volume was less than 20% of the preoperative volume, no tumor growth occurred over an average of 44.6 months of follow‐up (P <. 01). Four tumors (33.3%) demonstrated serial growth at a mean of 23.5 months following resection, 2 of which were treated with salvage stereotactic radiotherapy providing control through the last recorded follow‐up. No patient experienced permanent postoperative lower cranial neuropathy as a result of surgery.ConclusionSubtotal resection of jugular paragangliomas with preservation of the lower cranial nerves is a viable management strategy. If more than 80% of the preoperative tumor volume is resected, the residual tumor seems less likely to grow.