European Journal of Biomedical and Pharmaceutical Sciences

DROP METASTASIS TO THE THORACIC SPINAL CORD FROM A JUGULO-TYMPANIC PARAGANGLIOMA WITH INTRA-CRANIAL EXTENSION. CASE REPORT AND LITERATURE REVIEW

Stylianos Pikis, MD, MSc, Georgios Mantziaris, MD, Chryssoula Glava, MD, Georgios Arealis, MD, *Tigran Petrosyan, MD

ABSTRACT

Cerebrospinal fluid dissemination (CSF) of paragangliomas has been rarely reported and only with spinal primaries. Time to cerebrospinal fluid dissemination is highly variable thus optimal management remains to be determined. A literature review identified four males and two females who presented with CSF dissemination following management of a spinal paraganglioma. One female patient who presented with drop metastasis from a jugulotympanic paraganglioma was also included. Mean age was 41 years (ranged from 15 to 74). Time to CSF dissemination ranged from four months to 22 years and multiple metastases were present in three patients. Metastasis management included surgery in two patients, surgery and adjuvant radiotherapy in two patients, radiotherapy alone in two patients and in one patient with multiple metastases peptide receptor radionucleid therapy with radiolabeled somatostatin analog was employed. Following treatment three patients were reported to improve, two worsened, and two remained stable. Long-term follow-up of patients diagnosed with intradural paragangliomas is necessary. Prospective studies are required to define optimal management of central nervous system paragangliomas presenting with CSF seeding.

Keywords: Paraganglioma; Jugulo-tympanic; Metastasis; Spinal cord; Intradural; Cerebrospinal fluid dissemination.