Management of skull base paragangliomas: The gruppo otologico experience of over 500 cases

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Mario Sanna

Otologico Piacenza Group, Italy

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Abstract

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Aim: The aim of this study was to share our review of management strategies and long-term outcomes in the management of skull base paragangliomas. Methods: This was a retrospective study. The records of 503 patients with 161 Class A & B tympanomastoid paragangliomas, 346 tympanojugular paragangliomas, 30 vagal paragangliomas, 11 carotid body tumors, were analyzed for tumor class, surgical procedure, preoperative vascular management, and perioperative sequelae. Results: Of class C1, C2, C3, and C4 tumors, we found 24.9%, 51.3%, 22.2%, and 1.6%, respectively. 56.2% tumors had intracranial extensions and 4.3% involved the vertebral artery. A single-stage procedure was adopted in 85.4% tumors. The infratemporal fossa type A approach was used in all cases. In 9.7%, an intra-arterial stenting of the internal carotid artery was performed. Gross-total tumor removal was achieved in 89.7% and 2.4% among them developed a recurrence. 55 patients with tympanojugular paragangliomas were subjected to wait and scan. 92% of tumors put on wait-and-scan did not show demonstrable growth in 3 years. Conclusion: A thorough understanding of skull base techniques and a logical decision-making process in the management of tympanojugular paragangliomas can achieve a high rate of success in terms of recurrences and complications. Wait-and-scan is a valid management protocol for a subset of patients.

Biography

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Mario Sanna is Founder and Director of the Gruppo Otologico (Piacenza-Rome, Italy), an internationally acclaimed center for otology, hearing implantology and skull base surgeries. He is master in his field known across the world for his pioneering work in Otology and Skull Base Surgery. He is the Founder member of the European Skull Base Society and the Italian Skull Base Society and an honorary member of the French and Spanish Otolaryngological Societies. He has authored 15 books and over 380 articles in peer reviewed journals. His illustrated text books are extremely popular and some of them have won international awards. He has been an invited faculty in over 250 conferences and academic meetings. Over 200 fellows and 500 observers have been trained at the Gruppo Otologico. He has contributed tremendously to the knowledge of otology & skull base surgery and is considered by his peers to be one of the pioneers of modern skull base surgery.

Email: mario.sanna@gruppootologico.it