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Sun W, Zhang Y, Li W, Li F, Feng Y, Wu Q, Dai C. The intrabulbar or extrabulbar growth pattern and its surgical outcomes of jugular foramen paragangliomas. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08769-9. [PMID: 38977468 DOI: 10.1007/s00405-024-08769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/28/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE This study is to define a subclassification system of jugular foramen paragangliomas (JFPs) and to demonstrate corresponding microsurgical outcomes of JFPs. STUDY DESIGN Retrospective study. SETTING A single-center study. METHODS We conducted a retrospective review of the clinical data of 44 patients with JFPs who underwent surgical management. Extrabulbar(Be) tumor and intrabulbar(Bi) tumor are defined based on the growth patterns, receiver operating characteristic (ROC) curves of the imaging profile were generated and was confirmed based on intraoperative findings. Area Under Curve (AUC), accuracy, sensitivity, and specificity for diagnostic imaging were revealed. We also compared the correlation between the two growth patterns with Fisch's classification, blood loss, lower cranial nerves (LCNs) deficit. RESULTS There are 27 (69%) cases of Bi tumor and 17 (39%) cases of Be tumor. Significant radiomics features between the two growth patterns were demonstrated, ROC curves achieved excellent AUCs for MRI sequences (T1W1 MRI, MR contrast-enhanced sequence, MR complex sequences and MR complex + DSA by 0.833, 0.833, 0.875, 0.944) and had statistically significant in diagnosis of two growth patterns (P<0.05). There was no statistical correlation between growth patterns of JFPs and intra-operative blood loss. Preoperative LCNs deficits and Fisch's classification of tumors were correlated with the growth patterns of JFPs (P < 0.05). CONCLUSION We proposetd two growth patterns of JFPs in term of the inferior petrous sinus involvement. Identification of Bi or Be growth patterns preoperatively is helpful to design optimal surgical strategies and minimize postoperative complications.
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Affiliation(s)
- Wenfang Sun
- Department of Otology and Skull Base Surgery, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University), Shanghai, 200031, PR China
- Research Center, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
- Department of Otolaryngology, Chongqing General Hospital, Chongqing, PR China
| | - Yibo Zhang
- Department of Otology and Skull Base Surgery, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University), Shanghai, 200031, PR China
- Research Center, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
| | - Wei Li
- Department of Otology and Skull Base Surgery, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University), Shanghai, 200031, PR China
- Research Center, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
| | - Feitian Li
- Department of Otology and Skull Base Surgery, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University), Shanghai, 200031, PR China
- Research Center, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
| | - Yisi Feng
- Department of Otology and Skull Base Surgery, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University), Shanghai, 200031, PR China
- Research Center, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
| | - Qianru Wu
- Department of Otology and Skull Base Surgery, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University), Shanghai, 200031, PR China
- Research Center, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China
| | - Chunfu Dai
- Department of Otology and Skull Base Surgery, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China.
- NHC Key Laboratory of Hearing Medicine, Fudan University), Shanghai, 200031, PR China.
- Research Center, Eye Ear Nose &Throat Hospital, Fudan University, Shanghai, 200031, PR China.
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Zhao P, Zhang Y, Lin F, Kong D, Feng Y, Dai C. Comparison of surgical outcomes between early and advanced class of jugular paragangliomas following application of our modified surgical techniques. Sci Rep 2023; 13:885. [PMID: 36650202 PMCID: PMC9845292 DOI: 10.1038/s41598-023-27821-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
To compare the safety and effectiveness of surgical treatment of jugular paragangliomas (JPs) following the application of our modified surgical techniques. Fifty-six patients with JPs were analyzed for tumor classification, surgical outcomes, and intratumor blood vessels. The gross total resection in C1-2 (100%) was significantly greater than that in C3 and D (66.7%). Good postoperative facial nerve (FN) function (House-Brackmann I-II) was achieved in 89.5% C1-2 cases, which was not significantly different from C3 and D (93.3%) (P = 0.694). Preoperative and postoperative lower cranial nerve (LCN) deficits correlated with the Fisch's classification of tumors (P < 0.05), and intraoperative blood loss was greater in advanced tumors (P = 0.050). Further study showed that the cross-sectional area of intratumor blood vessels was positively associated with intraoperative blood loss (P < 0.001). Surgical excision of JPs is a safe and effective strategy, and early surgical treatment is a good option for patients with C1-2 tumors without surgical contraindications.
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Affiliation(s)
- Peng Zhao
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Department of Otolaryngology Head and Neck Surgery, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China
| | - Yibo Zhang
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China. .,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.
| | - Feng Lin
- Department of Otolaryngology Head and Neck Surgery, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, 353000, China
| | - Dedi Kong
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Yisi Feng
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Chunfu Dai
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China. .,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.
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Graham NJ, Smith JD, Else T, Basura GJ. Paragangliomas of the head and neck: a contemporary review. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:R153-R162. [PMID: 37435464 PMCID: PMC10259325 DOI: 10.1530/eo-22-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 07/13/2023]
Abstract
Head and neck paragangliomas (HNPGLs) are slow-growing, vascular, typically benign tumors whose growth may induce significant lower cranial nerve deficits. While most tumors arise sporadically, a significant portion is associated with defined genetic syndromes. While surgical resection has historically been the gold standard, management strategies have evolved with acknowledgement of high surgical morbidity, slow tumor growth rates, and technological advances. Conservative management approaches via observation and newer radiation therapy techniques have become more common. This review seeks to provide an update on contemporary management strategies for HNPGLs and future directions.
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Affiliation(s)
- Nathan J Graham
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gregory J Basura
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Kong D, Zhang Y, Li F, Li W, Dai C. Tension-Free Anterior Rerouting of the Facial Nerve in Management of Jugular Foramen Paragangliomas. Laryngoscope 2021; 131:2684-2687. [PMID: 34050950 DOI: 10.1002/lary.29658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Dedi Kong
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Yibo Zhang
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Feitian Li
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Wei Li
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chunfu Dai
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
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