When Is Skull Base Paraganglioma Tumor Surgery Needed?
The decision to remove a skull base paraganglioma is based on several factors. Some of these include:
- how fast the tumor is growing,
- the tumor size and location,
- what nerves the tumor affects,
- whether you have multiple paragangliomas, and
- your overall health.
Sometimes, we use a treatment called stereotactic radiosurgery to send radiation into the tumor to shrink it or stop it from growing. Stereotactic radiosurgery may be used as a standalone treatment, along with surgery, or for tumors that have grown after previous surgery.
We will use the best treatment approach for your risk factors and needs.
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Why Choose University of Utah Health?
The skull base tumor specialists at U of U Health are among the most experienced in the Mountain West. We treat around 200 patients with new skull base tumor diagnoses each year, making us the region's highest-volume skull base tumor program. Our specialists treat approximately 30 skull base paragangliomas each year—other institutions often treat only one or two in the same timeframe.
When you choose U of U Health, you receive multidisciplinary, collaborative care among providers, such as:
- neurotologists (lateral skull base surgeons)
- neurosurgeons (skull base brain and spine surgeons),
- radiation oncologists,
- endocrinologists,
- medical oncologists,
- geneticists and genetic counselors,
- radiologists (neuroradiologists and interventional radiologists), and
- other experts.
We research skull base tumor treatment and can offer patients access to new therapies not available elsewhere in the region through clinical trials.
What to Expect at Your First Visit
Before your visit, we'll ask you to bring or send all test results you’ve had related to your paraganglioma, such as:
- computed tomography (CT) scans,
- magnetic resonance imaging (MRI),
- hearing tests (audiogram with speech testing),
- balance tests (videonystagmography or VNG), and
- genetic tests.
If you haven't had any of these tests, let our scheduling team know and our providers will advise you on which tests you'll need before and/or after your initial consultation.
At your first appointment, you will meet with our surgical team, such as a neurotologist or head and neck surgeon. Your provider will review your past tests and ask about your symptoms. Depending on what tests you’ve already had, we may run additional tests, such as:
- audiogram, a hearing evaluation;
- nasopharyngoscopy, an exam of the back of your throat with a scope; or
- swallow study, a real-time X-ray that records your throat and esophagus (swallowing tube) as you swallow.
In addition to imaging of the head and neck, you may undergo a whole-body scan (such as a positron emission tomography (PET) scan) to look for other paraganglioma tumors in your body. Developing paraganglioma tumors elsewhere in your body is rare.
The first appointment will typically be 30 to 45 minutes, but allow additional time to coordinate other appointments, tests, lab work, etc.
How to Prepare for Surgery
Most patients will come to the hospital the day before paraganglioma surgery to undergo an embolization procedure. During your embolization, the interventional neurosurgeon will:
- insert a long, hollow tube (catheter) through a blood vessel in your groin;
- send a special dye through the catheter to highlight the blood vessels around the tumor so they can see blood flow more clearly; and
- place materials called microbeads in the blood vessels that feed the tumor to decrease blood flow in the tumor.
You will stay in the hospital overnight so we can monitor you for rare complications such as stroke. You will have a bandage over the catheter insertion site. Pain from the procedure is minimal.
During Your Skull Base Paraganglioma Tumor Surgery
We will give you general anesthesia on the day of surgery so you remain asleep. We will place a tube to help you breathe and equipment that monitors muscles and nerves in the face and neck. This equipment allows us to monitor the status of nerves around or involved by the tumor.
Surgery usually lasts around six to eight hours. During the operation, a neurotologist (ear, nose, and throat surgeon specializing in the inner ear) will:
- make an incision (cut) behind your ear extending to the upper part of your neck;
- remove bone around the tumor; and
- remove the tumor using tiny surgical instruments with the aid of a microscope.
A neurosurgeon may perform part of the surgery if the tumor extends through the brain's lining (dura). A head and neck surgeon may perform part of the surgery if the tumor extends to your neck.
What to Expect after Paraganglioma Surgery
You may spend the night of surgery in the intensive care unit (ICU) or you may recover in the Neuro Acute Care Unit (NACU). Most patients spend one to three nights in the hospital.
Sometimes, we use a fat graft from your abdomen to reconstruct the area in your neck where we removed the tumor. If we do, we'll place a drain under the skin that will stay in place while you recover in the hospital.
If the tumor affected your swallowing nerves, you may use a feeding tube for nutrition after surgery. Sometimes, you only need a feeding tube while in the hospital. In rare cases, you may need to use it after leaving the hospital for up to four weeks. Your surgical team will give you instructions on how long you'll need to use the feeding tube and how to care for it at home.
Paraganglioma Recovery Time
Recovery takes between two and four weeks. Your recovery time can vary depending on what nerves the tumor affected and whether the tumor went through the brain's lining. Tumors that go through the lining of the brain are rare.
Once you are home, most patients can usually manage postsurgical pain with over-the-counter medications. You may have some crackling or ringing in the ear that's next to the incision (cut). You may also have some mild neck swelling or tightness.
During your recovery, you will be able to walk, drive, and carry out most typical daily activities. For about two weeks, you'll need to avoid:
- blowing your nose,
- vigorous coughing, or
- lifting more than 10 pounds. Lifting restrictions may last up to 12 weeks if the surgery involves the brain's lining.
You'll have an appointment to remove the staples or sutures (stitches) in your head and neck about 10 to 14 days after surgery.
Surgery Complications
Paraganglioma tumors and the surgery to remove them can affect the nerves that control voice and speech, swallowing, shoulder function, and facial movement. Some patients already have problems with these functions before surgery because of the tumor. Rarely, patients develop these problems after surgery.
During this period, your surgical team will offer treatments while these affected nerves recover, including:
- eye drops or ointments,
- swallowing exercises,
- speech therapy, or
- physical therapy
Follow-Up After Paraganglioma Surgery
We'll take images, such as MRIs or CT scans, around three to six months after tumor removal. Imaging frequency varies depending on the tumor size and treatment. Your follow-up visits will be scheduled at least once a year for several years.
We may intentionally leave a small portion of the tumor intact if removing it would threaten critical nerve functions. In these cases, you may have stereotactic radiosurgery with a radiation oncologist and neurotologist to keep the tumor from growing.
You also may have follow-up care with a laryngologist who specializes in speech and swallowing rehabilitation.
Do Paragangliomas Grow Back After Removal?
Rarely, paragangliomas may grow back after removal. But they typically grow very slowly. With proper imaging and follow-up care, we can detect a paraganglioma quickly and treat it before it causes complications.
Find A Specialist
Next Steps
If you believe you need an evaluation for a paraganglioma, you can make an appointment with one of our skull base tumor specialists.
No doctor referral is necessary to visit us, but please check with your insurance first as some insurance companies require referrals.
Get a Consultation
Not located in Utah? You can contact us for a consultation. Once we have scheduled the call, we will set up a phone call to discuss your diagnosis with you. We will also ask you to send us:
- Copy of the CD of your MRI images,
- Copy of your audiogram (hearing test), and
- Copies of any balance testing (VNG) or auditory brainstem response (ABR) tests.