Vagal Paraganglioma and Schwannoma—Surgical or Non-surgical Management
Vagal paragangliomas and schwannomas have traditionally been treated by surgical excision. Surgery is however associated with very high rates of permanent Vagal paralysis, and alternate treatments have therefore been explored for patients with preserved vagal nerve function.
Vagal paragangliomas that are minimally symptomatic with preserved nerve function, or in the elderly or high surgical risk patient, may be suitably managed by periodic MR scanning to ascertain for manifest growth prior to initiating treatment. Surgery and its morbidity may therefore be temporarily or permanently deferred, though tumor growth and new cranial nerve palsies are reported in 55% over a 4 year median follow up. Concerns also exist regarding the potential for associated malignancy. Fractionated Radiation is effective in preventing tumor growth but concerns exist of breakout growth in the long term. Surgery when undertaken should be accompanied by thyroplasty and rehabilitative procedures to minimize the morbidity of vagal paralysis.
Patients should be involved in formulating an individualized treatment plan. Genetic testing may help in prognostication and treatment selection and its value is likely to increase in the future.
Non-surgical treatments for Schwannoma in the nature or watchful waiting and stereotactic radiation are not yet fully tested but are promising alternatives.
KeywordsVagal paraganglioma Vagal schwannoma Natural history Surgery Radiotherapy
- 33.Ahmad N, Netterville JL. How to manage extensive carotid body tumors. In: Cernea CR, Dias FL, Fliss D, Lima RA, Myers EN, Wei WI, editors. Pearls and pitfalls in head and neck surgery: practical tips to minimize complications. Basel: Karger; 2012. p. 158–9.Google Scholar
- 63.Kaufman I, Lee KBS, Danish A. Extracranial vagus nerve schwannoma treated with CyberKnife radiosurgery-case report. In: 18th annual meeting highlights. American College of Radiation Oncology. 2008.Google Scholar