ABSTRACT
Paragangliomas are slow growing, hypervascular neuroendocrine tumors that develop in the extra-adrenal paraganglion tissues. Paraganglioma involving the vagus nerve ganglia is termed glomus vagale. The slow growth of head and neck paragangliomas especially in the absence of symptom may obviate the necessity for any active intervention, in which case, a "wait and scan" policy is implemented involving long-term clinical and radiologic follow-ups. We present a case of a 71-year-old female with an untreated left glomus vagale who underwent a conservative "wait and rescan" plan of management and the tumor was observed with 8 serial MRI scans over a period of 7.4 years. A growth rate analysis was conducted which demonstrated a slow growth. A literature review of radiologic studies examining the natural history of head and neck paragangliomas was also performed.
ABSTRACT
OBJECTIVES/HYPOTHESIS: To quantify the postoperative quality of life (QOL) in patients following vestibular schwannoma surgery in a new multidisciplinary skull base unit. STUDY DESIGN: Cross-sectional study. METHODS: The Australian Short Form 36 (SF-36) quality of life health questionnaire was administered to 121 consecutive patients surgically treated for vestibular schwannoma between 1999 and 2007 at Westmead Hospital, New South Wales, Australia. QOL scores were calculated using a standardized process across the eight SF-36 health domains and compared to sex- and age- matched healthy Australian population. RESULTS: An 81% response rate (98 patients) was obtained. The postoperative QOL in vestibular schwannoma patients was significantly less than the appropriate matched healthy Australian population in one health domain of role physical limitation (P < .05). Analysis of preoperative patient factors (age, gender) and surgical factors such as tumor size (cutoff points of 15 mm or 25 mm) together with, surgical approach (translabyrinthine and retrosigmoid) showed no significant difference in QOL outcomes for each of these variables (P < .05). CONCLUSIONS: Results indicate that patients following vestibular schwannoma surgery reported near equivalent QOL as the healthy population. Advances in surgical techniques and experiences have minimized morbidities associated with vestibular schwannoma surgery. Significant physical role limitation encountered postoperatively may relate to facial nerve dysfunction, vestibular dysfunction, tinnitus or hearing loss that may persist after surgery. Careful patient selection, as well as, appropriate preoperative counselling, multidisciplinary follow-up and rehabilitation should be offered to all surgical candidates. A measured approach should still be considered for patients with small, slow growing tumors with minimal symptoms.
