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Surgical Management of a Functional Paraganglioma of the Infratemporal Fossa.

Tritter AG, Selber J, Kupferman ME - J Neurol Surg Rep (2015)

Bottom Line: Background Paragangliomas are rare neural crest tumors that can manifest in the head and neck as either functional or more commonly as nonfunctional lesions.Like other tumors of this space, surgical management is challenging on account of complex anatomy and nearby critical structures.Following preemptive embolization and autonomic pharmacotherapy, his tumor was successfully resected via a transfacial maxillary swing approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States ; Baylor College of Medicine, Houston, Texas, United States.

ABSTRACT
Background Paragangliomas are rare neural crest tumors that can manifest in the head and neck as either functional or more commonly as nonfunctional lesions. Paragangliomas of the infratemporal fossa are exceedingly rare, with no more than a handful of documented cases. Like other tumors of this space, surgical management is challenging on account of complex anatomy and nearby critical structures. Methods A 44-year-old man presented with a right infratemporal fossa functional paraganglioma. Following preemptive embolization and autonomic pharmacotherapy, his tumor was successfully resected via a transfacial maxillary swing approach. Results This case highlights the surgical management of a functional paraganglioma of the infratemporal fossa while demonstrating the effectiveness of a transfacial maxillary swing approach for both exposure and resection. Conclusion Although this report summarizes much of the literature on paragangliomas, there is still much to uncover regarding the fundamental features and genetic etiology of these lesions.

No MeSH data available.


Related in: MedlinePlus

Preoperative magnetic resonance Imaging of the head and face. (A) Axial T1 view of lesion in right infratemporal fossa. (B) Axial T1 view with contrast; same level as (A). (C) Axial T2 view; same level as (A). (D, E) Anterior to posterior sequence of coronal T1 images with contrast. (F) Sagittal T1 image with contrast.
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FI140008-3: Preoperative magnetic resonance Imaging of the head and face. (A) Axial T1 view of lesion in right infratemporal fossa. (B) Axial T1 view with contrast; same level as (A). (C) Axial T2 view; same level as (A). (D, E) Anterior to posterior sequence of coronal T1 images with contrast. (F) Sagittal T1 image with contrast.

Mentions: At the time of referral to our service, the patient complained of increasing right-sided nasal congestion, although he denied any nasal drainage, epistaxis, cranial neuropathies, or ocular issues. His head and neck examination was negative for any overt masses by palpation, although fiberoptic nasal endoscopy did reveal a hypervascular soft tissue mass emanating from the right middle meatus with involvement of the posterior aspect of the right maxillary sinus (Fig. 2). Magnetic resonance imaging (MRI) of the skull base was acquired that demonstrated a large skull base mass bulging into the middle cranial fossa with numerous internal flow voids and associated destruction of the right sphenoid sinus, greater sphenoid wing, orbital fissures, and right pterygopalatine fossa (Fig. 3). Additionally, the mass appeared to be intimately associated with the right optic fissure, optic canal, and cavernous carotid artery. These imaging findings were consistent with either a juvenile angiofibroma or a PGL. However, given the patient's endocrine findings, the lesion was diagnosed clinically as a functional PGL.


Surgical Management of a Functional Paraganglioma of the Infratemporal Fossa.

Tritter AG, Selber J, Kupferman ME - J Neurol Surg Rep (2015)

Preoperative magnetic resonance Imaging of the head and face. (A) Axial T1 view of lesion in right infratemporal fossa. (B) Axial T1 view with contrast; same level as (A). (C) Axial T2 view; same level as (A). (D, E) Anterior to posterior sequence of coronal T1 images with contrast. (F) Sagittal T1 image with contrast.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4520974&req=5

FI140008-3: Preoperative magnetic resonance Imaging of the head and face. (A) Axial T1 view of lesion in right infratemporal fossa. (B) Axial T1 view with contrast; same level as (A). (C) Axial T2 view; same level as (A). (D, E) Anterior to posterior sequence of coronal T1 images with contrast. (F) Sagittal T1 image with contrast.
Mentions: At the time of referral to our service, the patient complained of increasing right-sided nasal congestion, although he denied any nasal drainage, epistaxis, cranial neuropathies, or ocular issues. His head and neck examination was negative for any overt masses by palpation, although fiberoptic nasal endoscopy did reveal a hypervascular soft tissue mass emanating from the right middle meatus with involvement of the posterior aspect of the right maxillary sinus (Fig. 2). Magnetic resonance imaging (MRI) of the skull base was acquired that demonstrated a large skull base mass bulging into the middle cranial fossa with numerous internal flow voids and associated destruction of the right sphenoid sinus, greater sphenoid wing, orbital fissures, and right pterygopalatine fossa (Fig. 3). Additionally, the mass appeared to be intimately associated with the right optic fissure, optic canal, and cavernous carotid artery. These imaging findings were consistent with either a juvenile angiofibroma or a PGL. However, given the patient's endocrine findings, the lesion was diagnosed clinically as a functional PGL.

Bottom Line: Background Paragangliomas are rare neural crest tumors that can manifest in the head and neck as either functional or more commonly as nonfunctional lesions.Like other tumors of this space, surgical management is challenging on account of complex anatomy and nearby critical structures.Following preemptive embolization and autonomic pharmacotherapy, his tumor was successfully resected via a transfacial maxillary swing approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States ; Baylor College of Medicine, Houston, Texas, United States.

ABSTRACT
Background Paragangliomas are rare neural crest tumors that can manifest in the head and neck as either functional or more commonly as nonfunctional lesions. Paragangliomas of the infratemporal fossa are exceedingly rare, with no more than a handful of documented cases. Like other tumors of this space, surgical management is challenging on account of complex anatomy and nearby critical structures. Methods A 44-year-old man presented with a right infratemporal fossa functional paraganglioma. Following preemptive embolization and autonomic pharmacotherapy, his tumor was successfully resected via a transfacial maxillary swing approach. Results This case highlights the surgical management of a functional paraganglioma of the infratemporal fossa while demonstrating the effectiveness of a transfacial maxillary swing approach for both exposure and resection. Conclusion Although this report summarizes much of the literature on paragangliomas, there is still much to uncover regarding the fundamental features and genetic etiology of these lesions.

No MeSH data available.


Related in: MedlinePlus