We 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.

In 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.

We would like to highlight that modern advances now 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 f unctional paragangliomas, preoperative biochemical control using alpha-blockers and volume expansion remains critical, yet is often under-discussed in purely surgical literature.[4]

We suggest future reports include more detailed neuroendocrine functional assessment, and consider long-term follow-up given the potential for recurrence and malignancy, particularly in succinate dehydrogenase subunit B (SDHB) mutation-related tumors. Genetic testing and surveillance should be incorporated into management algorithms.

Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflict of Interest: The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding: The author received no financial support for the research and/or authorship of this article.

References

1) 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.

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.

3) 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.

4) 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.