Management of bilateral head and neck paragangliomas at a single-institution across four decades.

ABSTRACT

BACKGROUND: Bilateral head and neck paragangliomas (HNPGLs) require nuanced management to balance tumor control with functional preservation. METHODS: All patients seen at a single-institution for bilateral paraganglioma between 1983 and 2023 were retrospectively reviewed. Demographics, genetic testing results, and tumor characteristics were analyzed and compared to treatment modality and cranial nerve outcomes. RESULTS: There were 49 patients with 116 tumors (90 carotid body tumors [CBTs], 15 vagal paragangliomas [VPs], and 11 jugular paragangliomas [JPs]). Twenty-six patients had SDH pathologic variants (PV). Surgical management was more commonly utilized in younger patients (OR 0.97, 95% CI 0.950-0.992) and for JPs (OR 9, 95% CI 1.386-58.443). In surgical cases, CBTs had a lower risk of postoperative cranial nerve deficits compared to JPs and VPs (OR 0.095, 95% CI 0.013-0.692). CONCLUSIONS: Younger patients with bilateral HNPGLs, especially those with JP and CBT, are more often treated with surgery. CBTs have lowest risk of cranial nerve deficits after surgery.