• Paolo Palmisciano, Navraj S Sagoo, Ali S Haider, Christian Ogasawara, Maya Ogasawara, Bin AlamerOthmanOKing Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Keemia S Heidari, Karuna M Raj, Gianluca Scalia, Giuseppe E Umana, Ajit A Krishnaney, Salah G Aoun, Peter G Passias, and Shaleen Vira.
• Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy. Electronic address: paolo.palmisciano94@gmail.com.
• World Neurosurg. 2022 May 1; 161: 190-197.e20.

BackgroundPrimary spine paragangliomas are rare tumors. Surgical resection plays a role, but aggressive lesions are challenging. We reviewed the literature on primary spine paragangliomas.MethodsPubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies on primary spine paragangliomas. Clinical-radiologic features, treatments, and outcomes were analyzed and compared between cauda equina versus non-cauda equina tumors.ResultsWe included 143 studies comprising 334 patients. Median age was 46 years (range, 6-85 years). The most frequent symptoms were lower back (64.1%) and radicular (53.9%) pain, and sympathetic in 18 patients (5.4%). Cauda equina paragangliomas (84.1%) had frequently lumbar (49.1%) or lumbosacral (29%) locations. Non-cauda equina tumors were mostly in the thoracic (11.4%), thoracolumbar (5.1%), and cervical (3.6%) spine. Median tumor diameter was 2.5 cm (range, 0.5-13.0 cm). Surgical resection (98.5%) was preferred over biopsy (1.5%). Decompressive laminectomy (53%) and spine fusion (6.9%) were also performed. Adjuvant radiotherapy was delivered in 39 patients (11.7%) with aggressive tumors. Posttreatment symptomatic improvement was described in 86.2% cases. Median follow-up was 19.5 months (range, 0.1-468.0 months), and 23 patients (3.9%) had tumor recurrences. No significant differences were found between cauda equina versus non-cauda equina tumors.ConclusionsSurgical resection is effective and safe in treating primary spine paragangliomas; however, adjuvant treatments may be needed for aggressive lesions.Copyright © 2022 Elsevier Inc. All rights reserved.

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