Introduction: Head and neck paragangliomas (HNPGL) are rare neuroendocrine tumors that arise in the parasympathetic or sympathetic ganglia. Surgical resection is the mainstay for curative therapy. Due to their proximity to blood vessels and cranial nerves, surgery increases the risk for nerval damage and functional impairment. The objective of this study was to evaluate the morbidity and health related quality-of-life (QOL) in a large cohort of patients who had undergone surgical treatment for HNPGL.
Materials and Methods: In total, 125 (carotid n=78, jugular n=31, vagal n=10) patients were recruited, who were treated surgically between 2006 to 2023 at the University Hospital Heidelberg. Clinical data was obtained and analyzed. Long-term QOL was assessed with a mean follow-up since surgery of 6.0 years using the German version of the EORTC QLQ- H&N43.
Results: Fifteen (12%) of patients presented with preoperative cranial nerve deficits and 34 patients (27.2%) suffered from postoperative brain nerve damage lasting at least six months after surgery. This rate differed according to the tumor localization (vagal: 70.0%, jugular: 45.2%, carotid body: 14.1%). In the QOL assessments, elevated symptoms were reported mainly in the scales Fear of progression, Coughing and Neurological problems.
Discussion: Surgical treatment of HNPGLs associated with morbidity and QOL impairment due to cranial nerve damage, dependent mainly on tumor localization. While the excision of carotid body tumors often does not compromise QOL, vagal and jugular tumors may lead to severe functional impairments in psychological and physical domains. Interdisciplinary treatment should include genetic diagnostic and consider the individual risks for postoperative impairments and their specific management.

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