A highly vascular skull-base tumour encases lower cranial nerves. Angiography confirms a paraganglioma. What is the safest principle before intervention?
Age, growth, cranial-nerve function, secretory status and carotid involvement determine management. Preoperative embolisation may help selected tumours but is not a substitute for a complete strategy.
A. Biopsy the mass transorally without vascular imaging: Unplanned biopsy can cause major haemorrhage.
B. Operate on every tumour immediately: Observation or radiotherapy may better preserve function in selected patients.
C. Plan treatment in a skull-base MDT, weighing observation, radiotherapy and surgery including vascular risk: Age, growth, cranial-nerve function, secretory status and carotid involvement determine management. Preoperative embolisation may help selected tumours but is not a substitute for a complete strategy.
D. Ignore catecholamine symptoms: Secretory tumours require biochemical and anaesthetic planning.
E. Sacrifice the carotid without collateral-flow assessment: This creates avoidable stroke risk.
If biochemical testing showed catecholamine secretion, alpha blockade would be required before invasive treatment.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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