case_images: PMC11380896_01
case_images: Vagal paraganglioma incidentally detected in a 47-year-old man. (a) Gadolinium-enhanced, T1-weighted magnetic resonance imaging (MRI) showing a well-enhanced tumor in the parapharyngeal space. (b) Positron emission tomography revealed increased fluorodeoxyglucose uptake within the lesion, with no evidence of metastasis to the other location. (c) Digital subtraction angiography showing the hypervascularity of the tumor, primarily supplied by the ascending pharyngeal artery. (d-f) Stereotactic radiosurgery (SRS) with Gamma Knife using mask fixation was performed, and radiosurgical planning images are shown in the axial, coronal, and sagittal planes. The yellow line indicates the 45% isodose line for the prescribed treatment dose of 14 Gy, and the green lines indicate the doses of 8, 10, and 17 Gy. (g-i) The patient's clinical course was uneventful, and MRI revealed significant tumor shrinkage with a 70% decrease in volume 25 months after SRS.
case_images: SNI-15-314-g001.jpg
case_images: PMC11380896_01_SNI-15-314-g001.jpg
case_images: F1
case_images: Gadolinium-enhanced magnetic resonance imaging (MRI) revealed a well-defined, enhancing, round mass localized between the pterygoid and longus capitis muscles (size, 35 x 29 x 55 mm; volume, 25.7 mL); [Figure 1 a]. Positron emission tomography revealed increased fluorodeoxyglucose uptake within the lesion with no evidence of metastasis to other locations [Figure 1b]. Digital subtraction angiography also showed hypervascularity of the lesion, which was primarily supplied by the ascending pharyngeal artery [Figure 1c]. AB) were used for fixation. Leksell frame (Elekta AB) fixation was not applicable in this case due to potential shoulder collisions. Preoperatively, contrast-enhanced cone-beam CT images were obtained to confirm consistent patient positioning during irradiation, ensuring accurate tumor targeting. A single-fraction marginal dose of 14 Gy was then delivered to the 45% isodose line [Figures 1d-f]. At the latest follow-up (25 months after SRS), a significant tumor reduction was observed (size: 25 x 19 x 46 mm, volume: 7.6 mL, a decrease of 70%), [Figures 1g-i] without any neurological deficits.