{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T08:13:15Z","timestamp":1788509595303,"version":"build-2803163510"},"reference-count":9,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Large carotid-space paragangliomas (LCSPs) are uncommon, highly vascular tumors that present significant operative challenges because of their intimate relationship to the carotid circulation, lower cranial nerves, and skull base. The central hazard in surgical management is not tumor size alone but uncertainty regarding vascular anatomy, collateral circulation, and operative conditions before incision. We describe a structured multimodality strategy to reduce this uncertainty before critical dissection.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n A retrospective review was performed of eight consecutive patients treated for LCSPs using a standardized multidisciplinary workflow involving neurovascular surgery, head and neck surgery, and neurointerventional surgery. Five tumors were carotid body tumors, and three were glomus vagale tumors (GVTs). Mean age was 55 years and mean maximum tumor diameter was 6.1 cm. Multifocal disease occurred in two patients (25%); one tumor was biochemically active. All patients underwent diagnostic angiography and preoperative embolization. Balloon test occlusion was performed in seven patients; six passed. Gross total resection was achieved in six patients (75%). Intentional subtotal resection was performed in two GVTs due to skull base extension. One patient subsequently underwent stereotactic radiosurgery for residual disease. Median estimated blood loss was 100 mL (mean 122 mL; range 25\u2013350 mL). No patient required transfusion, had perioperative stroke, carotid sacrifice, or major vascular complication. Two patients developed new postoperative vagal\/recurrent laryngeal nerve dysfunction at 6-week follow-up. Median length of stay was 2 nights.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n A structured multimodality strategy emphasizing preoperative uncertainty reduction was associated with favorable outcomes in our case series. Surgical endpoints were determined by anatomy rather than dogmatic pursuit of complete resection, providing a reproducible framework for LCSP management.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_714_2026","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T07:28:10Z","timestamp":1788506890000},"page":"509","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodality management of large carotid-space paragangliomas: A single-center case series"],"prefix":"10.25259","volume":"17","author":[{"given":"Zo\u00eb M.","family":"Rushetsky","sequence":"first","affiliation":[{"name":"Department of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, Suwanee, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiyin","family":"Sokoya","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Wellstar Medical Group, Roswell, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Wellstar Medical Group, Roswell, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnny","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology, Wellstar Medical Group, Roswell, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Colon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wellstar Medical Group, Roswell, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Zussman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wellstar Medical Group, Roswell, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"10.25259\/SNI_714_2026\/ref-1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1288\/00005537-199503000-00001","article-title":"Management of the internal carotid artery during carotid body tumor surgery","volume":"105","author":"Anand","year":"1995","journal-title":"Laryngoscope"},{"key":"10.25259\/SNI_714_2026\/ref-2","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.3390\/cancers17061029","article-title":"Pheochromocytomas and paragangliomas-current management","volume":"17","author":"Brewczy\u0144ski","year":"2025","journal-title":"Cancers (Basel)"},{"key":"10.25259\/SNI_714_2026\/ref-3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3390\/complications3010003","article-title":"Anesthesia management in carotid paraganglioma surgery: How to address the complexities and ensure safety","volume":"3","author":"Franchin","year":"2026","journal-title":"Complications"},{"key":"10.25259\/SNI_714_2026\/ref-4","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1186\/s13019-024-02951-0","article-title":"Carotid body tumor: Characteristics and surgical outcome","volume":"19","author":"Kakamad","year":"2024","journal-title":"J Cardiothorac Surg"},{"key":"10.25259\/SNI_714_2026\/ref-5","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.3390\/jcm15072508","article-title":"Microsurgical management of carotid body tumors: An educational neurosurgical perspective with video demonstrations","volume":"15","author":"Keles","year":"2026","journal-title":"J Clin Med"},{"key":"10.25259\/SNI_714_2026\/ref-6","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1186\/s12957-025-03901-3","article-title":"Preoperative embolization of head and neck tumors: A systematic review and meta-analysis","volume":"23","author":"Long","year":"2025","journal-title":"World J Surg Oncol"},{"key":"10.25259\/SNI_714_2026\/ref-7","doi-asserted-by":"crossref","first-page":"20503121211005229","DOI":"10.1177\/20503121211005229","article-title":"The effect of preoperative embolization on surgical outcomes for carotid body tumor resection","volume":"9","author":"Osofsky","year":"2021","journal-title":"SAGE Open Med"},{"key":"10.25259\/SNI_714_2026\/ref-8","doi-asserted-by":"crossref","first-page":"914","DOI":"10.3390\/medicina60060914","article-title":"Paragangliomas of the head and neck: A review of the latest diagnostic and treatment methods","volume":"60","author":"Palade","year":"2024","journal-title":"Medicina (Kaunas)"},{"key":"10.25259\/SNI_714_2026\/ref-9","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1111\/jop.13286","article-title":"Paragangliomas of the head and neck","volume":"51","author":"Valero","year":"2022","journal-title":"J Oral Pathol Med"}],"container-title":["Surgical Neurology 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