Jugular paraganglioma – upfront radiosurgery

SKULL BASE REGION Jugular foramen

  • Normal blood and urine catecholamines/metanephrines

  • Succinyl dehydrogenase subunit D (SDHD) mutation

Case description

The 19-year-old patient was evaluated for left-sided pulsatile tinnitus and intermittent aural fullness as a teenager and found to have multiple paragangliomas (left jugular paraganglioma, bilateral carotid body paragangliomas, and right vagal paraganglioma) associated with familial paraganglioma syndrome (SDHD mutation) ( Figure 10.50.1 ). Initial examination did not reveal cranial neuropathies, and the patient exhibited normal hearing bilaterally. Given the large size of the left jugular paraganglaioma and the right vagal paraganglioma, which could threaten the contralateral vagus nerve, the decision was made to proceed with upfront stereotactic radiosurgery (SRS) of the left jugular paraganglioma ( Figure 10.50.2 ).

Radiosurgery Machine Gamma Knife
Radiosurgery Dose (Gy) 16 at the 50% isodose line
Number of Fractions 1

Figure 10.50.1.

A. Initial MRI 1 month prior to stereotactic radiosurgery (SRS): Axial T1-weighted image with gadolinium showing a brightly enhancing mass abutting the internal carotid artery and involving the left jugular foramen and bulb. B. Initial MRI 1 month prior to SRS: Coronal T1-weighted image with gadolinium. C. Initial CT 1 month prior to SRS: Axial noncontrasted image showing evidence of jugular-carotid spine erosion.

Figure 10.50.2.

Imaging of the treatment plan. Yellow line, 16 Gy; Green line, 8 Gy.

Apr 6, 2024 | Posted by in GENERAL RADIOLOGY | Comments Off on Jugular paraganglioma – upfront radiosurgery

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