An Unusual Paraganglioma of the Left Vagus Nerve: A Surgical Conundrum

TL;DR

This paper presents a rare case of a paraganglioma on the left vagus nerve in a 76-year-old woman, highlighting the challenges in diagnosis and surgical management.

Contribution

The paper adds to the limited literature on vagus nerve paragangliomas by describing a unique clinical case and surgical dilemma.

Findings

The tumor was diagnosed as a left vagus nerve paraganglioma based on imaging, without a biopsy.

Surgical resection is challenging due to the tumor's involvement with nerve and vascular structures.

Early diagnosis and management are critical to avoid increased patient morbidity.

Abstract

Vagus nerve paragangliomas (PGL) are tumors derived from neural crest cells of very low incidence, and cervical PGL of the vagus nerves (VPGLs) are tumors, of which the nature and location make them extremely rare, representing only 0.012% of cervical tumors, with an incidence of 1:30,000-1:200,000. A 76-year-old woman presented with a rapid growth in volume in the left laterocervical region, accompanied by pain for four months. She denied voice changes, difficulty feeding, facial nerve paralysis, headache, hypertension, hearing loss, excessive sweating, tinnitus, and tremors. Catecholamines were requested in blood or urine, which were negative. A computed tomography angiography of the head and neck was performed, where a tumor was identified whose location and characteristics were diagnosed as a PGL of the left vagus nerve; no biopsy was performed. Head and neck surgeons should be aware of large vagal PGL involving nerve or vascular structures, as it is currently difficult to resect the tumor without sacrificing the vagus nerve, and postponing surgery may also increase patient morbidity.

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