Surgical management of para-aortic paragangliomas: case series of functional and non-functional tumors

Introduction: Para-aortic paragangliomas (PGLs) are rare neuroendocrine tumors that may present with or without catecholamine hypersecretion. Their surgical management requires meticulous preoperative evaluation and careful intraoperative technique due to their proximity to major vascular structures. This report is novel in directly comparing functional and non-functional para-aortic PGLs, with an emphasis on perioperative strategy and surgical outcomes. Case Presentations: We report two cases of para-aortic PGLs managed successfully with surgical resection. The first case involved a 45-year-old hypertensive male presenting with episodic headaches and palpitations. Biochemical tests confirmed catecholamine excess, and imaging revealed a 3 × 3.5 cm hypervascular mass at the aortic bifurcation, consistent with a functional paraganglioma. Following adequate preoperative alpha- and beta-blockade, complete tumor excision was achieved (operative time: 135 minutes, estimated blood loss: 120 mL), with resolution of symptoms and normalization of catecholamine levels. The second case involved a 52-year-old normotensive male with non-specific abdominal discomfort. Imaging demonstrated a 5 × 5 cm retroperitoneal mass between the aorta and infrarenal inferior vena cava. Biochemical markers were within normal limits, consistent with a non-functional paraganglioma. Surgical resection was performed without adrenergic blockade (operative time: 160 minutes, estimated blood loss: 150 mL), and postoperative recovery was uneventful. Discussion: This case series highlights key perioperative and pathological differences between functional and non-functional para-aortic PGLs and compares them with previously reported series, emphasizing tailored surgical planning. Conclusion: Surgical excision remains the definitive treatment for both functional and non-functional para-aortic PGLs. Comprehensive biochemical evaluation, precise imaging, and individualized perioperative management are critical to achieving favorable results while minimizing perioperative risks.