Subtotal Resection of Jugular Paragangliomas

Historically, the mainstay of treatment for jugular paraganglioma has been gross total resection. While this strategy has led to relatively low recurrence rates [1–5], it has often been pursued at the expense of cranial nerve function. This trade-off was especially true for larger tumors extending through the pars nervosa of the jugular foramen and those with intracranial extension. Bacciu et al. [6] recently reviewed 122 patients with Fisch class C and D jugular paraganglioma and found that 54% of patients developed one or more new cranial nerve deficits after surgery with gross total resection being achieved in 86% of cases. Similarly, the Vanderbilt Otology Group’s review of 202 patients with jugular paragangliomas found a 60% rate of new cranial nerve injuries after performing gross total resection in 90% of cases [2, 7].