Abstract：
Paragangliomas are the most common tumors at jugular foramen and pose a great surgical challenge. Careful clinical history and physical examination must be performed to adequately evaluate neurological deficits and its chronologic evolution, also to delineate an overview of the patient performance status. Complete imaging evaluation including MRI and CT scans should be performed, and angiography is a must to depict tumor blood supply and sigmoid sinus/internal jugular vein patency. Screening for multifocal paragangliomas is advisable, with a whole-body imaging. Laboratory investigation of endocrine function of the tumor is necessary, and adrenergic tumors may be associated with synchronous lesions. Preoperative prepare with alpha-blockage is advisable in norepinephrine/epinephrine-secreting tumors; however, it is not advisable in exclusively dopamine-secreting neoplasms. Best surgical candidates are young otherwise healthy patients with smaller lesions; however, treatment should be individualized each case. Variations of infratemporal fossa approach are employed depending on extensions of the mass. Regarding facial nerve management, we avoid to expose or reroute it if there is preoperative function preservation and prefer to work around facial canal in way of a fallopian bridge technique. If there is preoperative facial nerve compromise, the mastoid segment of the nerve is exposed, and it may be grafted if invaded or just decompressed. A key point is to preserve the anteromedial wall of internal jugular vein if there is preoperative preservation of lower cranial nerves. Careful multilayer closure is essential to avoid at most cerebrospinal fluid leakage. Residual tumors may be reoperated if growing and presenting mass effect or be candidate for adjuvant stereotactic radiosurgery.
摘要：
副神经节瘤是颈静脉孔最常见的肿瘤，构成了巨大的手术挑战。必须进行仔细的临床病史和体格检查，以充分评估神经功能缺损及其时间演变。还描绘了患者表现状态的概述。应进行完整的影像学评估，包括MRI和CT扫描，血管造影是描绘肿瘤血液供应和乙状窦/颈内静脉通畅的必要条件。建议筛查多灶性副神经节瘤，全身成像。有必要对肿瘤的内分泌功能进行实验室检查，和肾上腺素能肿瘤可能与同步病变有关。对于去甲肾上腺素/肾上腺素分泌性肿瘤，术前准备α-阻断是可取的；然而，在仅分泌多巴胺的肿瘤中是不可取的。最好的手术候选人是年轻的健康患者，病变较小；然而，每个病例的治疗应该是个体化的。根据质量的扩展，采用颞下窝方法的变化。关于面神经管理，如果术前保留功能，我们避免暴露或改道，并且更喜欢以输卵管桥技术在面管周围工作。如果术前出现面神经受损，神经的乳突部分暴露出来,如果入侵或只是减压，它可能会被嫁接。如果术前保留下颅神经，关键是要保留颈内静脉的前内壁。仔细的多层闭合对于避免脑脊液漏至关重要。如果残留的肿瘤正在生长并表现出质量效应，或者是辅助立体定向放射外科的候选者，则可以再次手术。
