Objective: To study the clinical features, diagnosis and treatment of vagal paraganglioma in parapharyngeal space. Methods: Nine cases with vagal paraganglioma in parapharyngeal space were retrospectively analyzed who were diagnosed and treated between January 2006 and December 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital and the First Medical Center, Chinese PLA General Hospital. There were 6 males and 3 females, aged from 24 to 50 years old. The main symptoms in the 9 patients were hoarseness and neck mass, and the secondary symptoms were irritating cough, cough on drinking and dysphagia. The main sign was a well-circumscribed round mass, tough in texture, with or without ipsilateral lateral oropharyngeal wall uplift and vocal cord paralysis. The tumors were located between the bifurcation of the carotid artery and the jugular foramen in 7 cases and intruded into jugular fossa in 2 cases. All the 9 patients underwent head and neck enhancement CT and MRI and 7 cases received digital subtraction angiography (DSA) examination and balloon occlusion test. The imaging features were tumors with rich blood supply in the parapharyngeal space of the upper neck, and the tumors were heterogeneous enhanced with contrast CT scan and enhanced MRI, which were closely related to the internal carotid artery, external carotid artery and jugular vein. Results: Among these 9 patients, 8 underwent surgical resection of tumors, including complete tumor resection in 7 cases and partial tumor resection in 2 case. One patient underwent partial tumor resection after being transferred to vascular surgery. There was no recurrence in 7 patients with complete tumor resection and slow growth was shown in 2 patients with partial tumor resection. Posterior cranial nerve injury occurred in 2 patients and stroke in 1 patient due to intraoperative ligation of internal carotid artery. Conclusions: Vagal paraganglioma in the parapharyngeal space is rich in blood supply and closely related to the internal and external carotid arteries, internal jugular vein and posterior cranial nerves. Surgical resection is the first choice for treatments. Choosing a reasonable operative approach for fully exposing the operative field and completely removing the tumor while protecting the internal carotid artery are the keys to successful surgery.
目的： 分析咽旁间隙迷走神经副神经节瘤（vagal paraganglioma，VP）的临床特点，总结和探讨其诊断与治疗方法。 方法： 回顾性分析2006年1月至2018年12月，就诊于首都医科大学附属北京友谊医院耳鼻咽喉头颈外科和解放军总医院第一医学中心耳鼻咽喉头颈外科，病理确诊为VP患者的临床资料，共9例，其中男性6例，女性3例，年龄24~50岁。9例患者主要症状为声音嘶哑、颈部包块，次要症状为刺激性干咳、饮水呛咳及吞咽哽噎。主要体征为一侧颈动脉三角区触及边界清晰类圆形肿物，质地较韧，伴或不伴有同侧口咽侧壁隆起及声带固定。9例肿瘤均位于咽旁间隙;7例位于颈动脉分叉与颈静脉孔区之间,2例突入颈静脉窝。9例患者均行头颈部增强CT和MRI检查。7例行数字减影血管造影（digital subtraction angiography，DSA）检查及球囊闭塞试验。影像学特征为咽旁间隙富血供肿瘤病变，增强扫描呈不均匀强化，与颈内外动脉、颈内静脉关系密切。 结果： 9例患者中8例于耳鼻咽喉头颈外科行颈外入路肿瘤切除术，其中7例肿瘤完整切除，1例行大部分切除；1例转至血管外科治疗后行肿瘤部分切除手术。7例肿瘤完整切除后无复发，2例部分切除术后肿瘤缓慢增长。2例术后出现后组颅神经损伤，1例因术中结扎颈内动脉导致脑卒中。 结论： VP为咽旁间隙富血供肿瘤病变，与颈内外动脉、颈内静脉及后组颅神经关系密切。治疗以手术切除为首选。选择合理的手术入路充分暴露术野，切除肿瘤同时保护颈内动脉是手术成功的关键。.
Keywords: Head and neck neoplasms; Paraganglioma; Vagus nerve.