Absence of the Contralateral Internal Carotid Artery: A Challenge for Management of Ipsilateral Glomus Jugulare and Glomus Vagale Tumors

Objective: Extensive involvement of the internal carotid artery (ICA) by jugular and vagal paragangliomas represents a challenging problem for skull-base surgeons: radical tumor resection and preservation of the vessel often cannot be achieved in these cases. The aim of this article was to report the management of a complex case of right ipsilateral jugular and vagal paragangliomas in a patient with absence of the contralateral ICA due to a previous removal of a left carotid body tumor. Surgical removal of the lesions was performed after stenting of the cervical and intratemporal segment of the ICA. Methods: The charts and all the examinations of the patient were retrospectively reviewed. The patient, a 40-year-old man, was treated at the Gruppo Otologico, a private quaternary referral center for neurotology and skull-base surgery. Results: The tumors were completely resected during surgery and manipulation of the ICA was greatly facilitated by the stent. No complication occurred during or immediately after surgery; after a follow-up period of 24 months there was no sign of recurrence and imaging studies demonstrated patency of the stented vessel. Conclusion: This report suggests that placement of endovascular stents in the cervical and temporal segments of the ICA has the potential of changing the whole therapeutic management in cases of temporal and vagal paragangliomas that surround and invade the vessel, especially in those cases in which permanent balloon occlusion of the ICA is not feasible.