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Background <p>Jugular paragangliomas (JPs) are rare, slow-growing neuroendocrine tumours arising from paraganglionic cells in the jugular foramen. Bilateral occurrences are exceptionally uncommon, comprising only 10% of all paragangliomas, and pose significant diagnostic and therapeutic challenges.</p> Case Presentation <p>We report a case of a 17-year-old male who presented with progressive bilateral hearing loss and episodic blood-stained ear discharge over three years. Imaging revealed bilateral jugular paragangliomas with extensive osseous and vascular involvement. A staged surgical approach was adopted, prioritizing the right-sided tumour due to a significantly dilated emissary vein on the left. Right subtotal petrosectomy was performed first, followed by left-sided surgery after assessing collateral venous circulation via MR venography. Preoperative embolization was done to minimize intraoperative bleeding. The tumours were successfully excised with facial nerve preservation by reconstruction using a spinal accessory nerve graft. The patient recovered well postoperatively and remains under regular follow-up.</p> Discussion <p>Bilateral JPs necessitate careful surgical planning to preserve neurovascular structures and prevent complications like cerebral oedema and cranial nerve deficits. Staged resections allow adaptation of venous outflow, reducing perioperative risks. Genetic screening is essential, given the hereditary association of these tumours. Advances in imaging, embolization, and surgical techniques improve outcomes in such complex cases.</p> Conclusion <p>This case highlights the importance of a multidisciplinary approach, individualized surgical strategy, and advanced imaging in managing bilateral jugular paragangliomas, ensuring optimal tumour resection while preserving vital neurovascular functions.</p>

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Two Sides, One Battle: A Case of Bilateral Jugular Paraganglioma

  • 期刊论文

  • 发表日期：

    2025年8月19日

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  • Shabbir Indorewala,
  • Girish Mishra,
  • Yojana Sharma,
  • Swara Bhatt,
  • Nidhish Shah

摘要

Background

Jugular paragangliomas (JPs) are rare, slow-growing neuroendocrine tumours arising from paraganglionic cells in the jugular foramen. Bilateral occurrences are exceptionally uncommon, comprising only 10% of all paragangliomas, and pose significant diagnostic and therapeutic challenges.

Case Presentation

We report a case of a 17-year-old male who presented with progressive bilateral hearing loss and episodic blood-stained ear discharge over three years. Imaging revealed bilateral jugular paragangliomas with extensive osseous and vascular involvement. A staged surgical approach was adopted, prioritizing the right-sided tumour due to a significantly dilated emissary vein on the left. Right subtotal petrosectomy was performed first, followed by left-sided surgery after assessing collateral venous circulation via MR venography. Preoperative embolization was done to minimize intraoperative bleeding. The tumours were successfully excised with facial nerve preservation by reconstruction using a spinal accessory nerve graft. The patient recovered well postoperatively and remains under regular follow-up.

Discussion

Bilateral JPs necessitate careful surgical planning to preserve neurovascular structures and prevent complications like cerebral oedema and cranial nerve deficits. Staged resections allow adaptation of venous outflow, reducing perioperative risks. Genetic screening is essential, given the hereditary association of these tumours. Advances in imaging, embolization, and surgical techniques improve outcomes in such complex cases.

Conclusion

This case highlights the importance of a multidisciplinary approach, individualized surgical strategy, and advanced imaging in managing bilateral jugular paragangliomas, ensuring optimal tumour resection while preserving vital neurovascular functions.