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It argues for modern combined endovascular and hybrid strategies, including intraoperative tumor perfusion monitoring and real-time navigation, and stresses that functional paragangliomas require preoperative biochemical control with alpha-blockers and volume expansion. The letter recommends more detailed neuroendocrine assessment, long-term follow-up for recurrence and malignancy, and incorporation of genetic testing and surveillance into management algorithms.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/comment-to-the-article-preoperative-planning-in-paraganglioma-resection-evolving-strategies-for-safer-outcomes/445506/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/comment-to-the-article-preoperative-planning-in-paraganglioma-resection-evolving-strategies-for-safer-outcomes/445506.png","ImageObject",300,407,{"name":92,"@type":93},"Finn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What key success factor does the letter attribute to managing para-aortic paraganglioma?","Question",{"text":112,"@type":113},"The letter highlights successful management through a multidisciplinary approach that includes preoperative embolization.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What earlier contribution does the letter say was missing from the cited references?",{"text":117,"@type":113},"It notes that a 1997 publication describing four patients with arterial and venous paragangliomas and the value of a preoperative pacemaker appears to have been overlooked.",{"name":119,"@type":110,"acceptedAnswer":120},"What future elements does the letter recommend for reports and ongoing management?",{"text":121,"@type":113},"It recommends more detailed neuroendocrine functional assessment, longer-term follow-up for recurrence and malignancy, and integrating genetic testing and surveillance into management algorithms.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},445506,1790765830,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","Turkish Journal of Thoracic and Cardiovascular Surgery 2025;33(4):584  \nLetter to the Edıtor / Editöre Mektup  \nComment to the article: Preoperative planning in paraganglioma resection:  \nEvolving strategies for safer outcomes  \nMakaleye yorum: Paraganglioma rezeksiyonunda ameliyat öncesi planlama: Daha güvenli son uçlar için gelişen stratejiler  \nKhaled Alebrahim􀀬  \nDepartment of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia  \nWe read with interest the recent report by Reyhanoğlu and Çakır “Para-aortic paraganglioma: Preoperative embolization and surgical resection”. [1] The successful management of this rare tumor through a multidisciplinary approach including preoperative embolization is commendable and reflects the ongoing progress in surgical strategies for highly vascular tumors such as paragangliomas .  \nIn a previous publication from our team in 1997, we reported on a series of four patients with arterial and venous paragangliomas and discussed the benefits of a preoperative pacemaker in cases associated with significant autonomic disturbance. [2] Unfortunately, this work appears to have been overlooked in the current article’s reference list, despite its relevance to the topic and its early emphasis on multidisciplinary planning.  \nWe would like to highlight that modern advancesnow enable combined endovascular and hybrid approaches, not only for embolization but also for intraoperative monitoring of tumor perfusion and real-time navigation . [3] Moreover, for functional paragangliomas, preoperative biochemical control using alpha-blockers and volume expansion remains critical, yet is often under-discussed in purely surgical literature. [4]  \nWe suggest future reports include more detailed neuroendocrine functional assessment, and consider long-term follow-up given the potential for  \nrecurrence and malignancy, particularly in succinate dehydrogenase subunit B (SDHB) mutation-related tumors . Genetic testing and surveillance should be incorporated into management algorithms .  \nData Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.  \nConflict of Interest: The author declared no conflicts of interest with respect to the authorship and/or publication of this article.  \nFunding: The author received no financial support for the research and/or authorship of this article.  \nREFERENCES  \n1. Reyhanoğlu H, Çakır V. Para-aortic paraganglioma: Preoperative embolization and surgical resection. Turk Gogus Kalp Dama 2025;33:382-5 . doi: 10.5606/tgkdc. dergisi.2025.26752 .  \n[2. al-Ebrahim K](2. al-Ebrahim K), el-Azm M, el-Kholy A, Shafei H. Arterial and venous paragangliomas: the value of a preoperative pacemaker and a multidisciplinary approach. Br J Neurosurg 1997;11:233-7. doi: 10. 1080/02688699746302 .  \n3. Ayala-Ramirez M, Feng L, Johnson MM, Ejaz S, Habra MA, Rich T, et al. Clinical risk factors for malignancy and overall survival in patients with pheochromocytomas and sympathetic paragangliomas: primary tumor size and primary tumor location as prognostic indicators. J Clin Endocrinol Metab 2011;96:717-25 . doi: 10.1210/jc.2010-1946 .  \n4. Fishbein L. Pheochromocytoma and paraganglioma: Genetics, diagnosis, and treatment. Hematol Oncol Clin North Am 2022;36:735-54 . doi: 10.1016/j.hoc.2022.04.003 .  \nCorresponding author: Khaled Alebrahim.  \nE-mail: [dr.k.ebrahim@gmail.com](dr.k.ebrahim@gmail.com)  \n[Doi: 10.5606/tgkdc.dergisi.2025.28432](Doi: 10.5606/tgkdc.dergisi.2025.28432)  \n[Received:](Received: August 05)[ August 05](Received: August 05) , 2025  \nAccepted: September 24, 2025  \nPublished online: October 20, 2025  \nCite this article as: Alebrahim K. Comment to the article: Preoperative planning in paraganglioma resection: Evolving strategies for safer outcomes. Turk Gogus Kalp Dama 2025;33(4):584 . doi: 10.5606/tgkdc.dergisi.2025.28432 .  \n©2025 All right reserved by the Turkish Society of Cardiovascular Surgery.  \nThis is an","cbCail5pmhdVUfKd","https://ap.wps.com/l/cbCail5pmhdVUfKd","pdf",174537,"English","# Letter to the editor\n## Preoperative embolization and multidisciplinary management\n## Earlier related work and its omission\n## Modern hybrid strategies and intraoperative monitoring\n## Functional tumor control and future recommendations\n## Data sharing, conflicts, funding, references","[{\"question\":\"What key success factor does the letter attribute to managing para-aortic paraganglioma?\",\"answer\":\"The letter highlights successful management through a multidisciplinary approach that includes preoperative embolization.\"},{\"question\":\"What earlier contribution does the letter say was missing from the cited references?\",\"answer\":\"It notes that a 1997 publication describing four patients with arterial and venous paragangliomas and the value of a preoperative pacemaker appears to have been overlooked.\"},{\"question\":\"What future elements does the letter recommend for reports and ongoing management?\",\"answer\":\"It recommends more detailed neuroendocrine functional assessment, longer-term follow-up for recurrence and malignancy, and integrating genetic testing and surveillance into management algorithms.\"}]","Comment to the article - Preoperative planning in paraganglioma resection: Evolving strategies for safer outcomes | PDF",1790712292]