Neck Lump Prompts Staged Resection of Dual Paragangliomas With 24-Hour Skull-Base Approach

Cohen Lynde underwent initial resection of the carotid-body tumor followed by delayed transmandibular access to the skull-base lesion after MRI demonstrated compromised cerebral perfusion. The second operation lasted twice the planned duration, necessitating tracheostomy, gastrostomy, and subsequent thyroplasty. Single-case reports cannot establish incidence yet align with known 1–2 per 100 000 annual paraganglioma rates and 10–20 % multifocality in non-syndromic patients. No germline testing was reported despite young age, a gap given that SDHB mutations confer 30–50 % malignancy risk and mandate lifelong surveillance imaging. Contemporary guidelines now recommend genetic panels at diagnosis to stratify recurrence and family screening intervals.