How to avoid intraoperative complications of active paragangliomas?

Edvin Zekaj; Marcella Callea; Christian Saleh; Guglielmo Iess; Phillip Jaszczuk; Luzius A Steiner; Viktorija Kenstaviciute; Domenico Servello

doi:10.25259/SNI_620_2023

How to avoid intraoperative complications of active paragangliomas?

Surg Neurol Int. 2023 Nov 24:14:405. doi: 10.25259/SNI_620_2023. eCollection 2023.

Authors

Edvin Zekaj¹, Marcella Callea², Christian Saleh³, Guglielmo Iess¹, Phillip Jaszczuk⁴, Luzius A Steiner⁵, Viktorija Kenstaviciute⁵, Domenico Servello¹

Affiliations

¹ Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy.
² Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
³ University of Basel, Basel, Switzerland.
⁴ Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland.
⁵ Department of Anesthesia, Surgical Intensive Care, Preclinical Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.

Abstract

Background: Paragangliomas (PGs) are very rare neuroendocrine tumors that can be found in unusual locations such as the spinal canal. Some PGs may be endocrinologically active, containing neurotransmitters such as noradrenaline, adrenaline, and serotonin. This can lead to unexpected neurotransmitter release during the removal of PGs, leading to a hypertensive crisis.

Case description: We present two patients who underwent surgical removal of a secretory filum terminale PG.

Conclusion: If laboratory tests are suggestive of a secretory tumor, surgery should include anesthesiologic preparation similar to cases of pheochromocytoma.

Keywords: Complications; Neuroendocrine tumors; Paraganglioma; Pre-operative Screening; Surgery.

Publication types

Case Reports