Paragangliomas are exceptionally rare tumors in children of neural crest origin. Our case report represents an extremely rare location for paraganglioma including its imaging features, perioperative challenges and histopathological characteristics. In the present case, a 10-year-old boy had headache and blurring of vision for four years but was not diagnosed until he came with malignant hypertension and hypertensive encephalopathy. The symptoms raised urinary catecholamines and CT findings confirmed the diagnosis of a functioning paraganglioma in presacral region. Challenges during surgery are to control the fluctuating blood pressure which may suddenly rise during tumor handling and suddenly fall following its removal. The unusual location of the tumor in pararectal region also made surgical resection difficult. Paragangliomas are rare and should be kept in mind while evaluating a child with hypertension and complete excision is the treatment of choice.
Paraganglioma

The objective of this study was to study the morphometry of the styloid process of temporal bone and prevalence of elongated styloid process. The morphology of elongated styloid process along with its embryological and clinical importance are discussed. The present study included 110 human dry skulls which were procured from the bone collections of the department of anatomy. The styloid process was observed macroscopically on both sides of all the skulls, the elongations if any were noted. All the styloids were measured for their length, thickness at different levels and interstyloid distance at various levels. Out of 110 specimens, only 5 skulls (4.5%) exhibited the elongated styloid process. Among them, 3 skulls (2.7%) had unilateral elongation and 2 skulls (1.8%) had bilateral elongation of the styloid process. The mean length of the styloid process was 17.8+/-9.3 mm and 18.2+/-5.6 mm for the right and left sides, respectively. The prevalence of elongated styloid process in the present study was 4.5%. The clinical anatomy of this congenital variant is important to the neurosurgeon and radiologist, while interpreting the computed tomogram and magnetic resonance image scans. The morphological knowledge of elongated styloid process is clinically important since the course of the vertebral artery may be distorted in such situations.
Humans ; Prevalence ; Skull ; Temporal Bone* ; Vertebral Artery