Paragangliomas of the Head and Neck: A Practical Approach to Diagnosis and Review of Detailed Anatomy at Sites of Origin

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Conference Proceeding - Restricted Access

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ASNR 2019 Proceedings


Purpose The objective of this presentation is to review related, detailed anatomy of the skull base jugular fossa, temporal bone and carotid space of the upper neck where most of the head and neck paragangliomas are found. Materials and Methods The authors will use original drawings to help the reader better understand the locations of the jugular fossa structures and to easily identify the location of the inferior tympanic canaliculus and mastoid canaliculus, which carry Jacobson's nerve and Arnold's nerve, branches of the CN IX and CN X, respectively. This will be followed by illustrations with MRI, CT and angiography images of the various types of paragangliomas and discussion of findings and differential diagnosis. Results Paragangliomas are slowly growing hypervascular neuroendocrine tumors arising from neural crest paraganglia cells distributed throughout the body. The largest concentration is in the adrenal medulla with smaller collections in the paravertebral space and head and neck region. Paragangliomas in the head and neck present with symptoms of mass effect such as cranial nerve palsy, palpable mass and tinnitus. Paragangliomas are rare, comprising50%. Glomus tympanicum, second most common, located within the tympanic cavity overlying the cochlear promontory. It originates from paraganglia cells of the inferior tympanic nerve (Jacobson's nerve), a branch of the glossopharyngeal nerve. Glomus jugulotympanicum arising from paraganglia cells of Arnold's nerve, a mastoid branch of the vagus nerve. Glomus jugulare, confined to the jugular fossa. Glomus vagale, originating from the inferior (nodose) ganglion of the vagus nerve. Conclusions The majority of paragangliomas in the head and neck occur in predictable anatomic locations. Knowledge of this anatomy along with characteristic imaging findings allows for accurate diagnosis.

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American Society of Neuroradiology, ASNR 2019 Annual Meeting, May 18-23, 2019. Boston MA. Meeting Abstract: 2822.

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