Vagus nerve-fibre preservation during resection of vagal paraganglioma: a case series with patient-reported outcomes.

Vagal paragangliomas are rare neuroendocrine tumours of the vagus nerve. Surgery typically causes vagus nerve paralysis with impairments of voice and swallow, and sometimes long-term gastrostomy dependence. We report a series of seven patients who underwent resections of enlarging, benign, non-functional vagal paragangliomas at a tertiary centre with attempted nerve-fibre preservation. MD Anderson Dysphagia Inventory (MDADI) and University of Washington Quality of Life scores were obtained by telephone interviews of six patients. Nerve-fibre preservation was achieved in three patients (43%), versus 5% reported in published systematic reviews. The preservation group had superior swallowing (mean MDADI composite 91 versus 66) and quality of life. No patient required tracheostomy or gastrostomy, and no tumour recurrence was identified at a mean follow-up of 10.5 years (range 6.4-12.7). Nerve-fibre preservation, when anatomically feasible, may reduce surgical morbidity without compromising local tumour control. Regionalisation of paraganglioma care and multi-centre data are needed.