Paraganglioma surgery may require different approaches, depending on the different relationships of the paraganglioma with the surrounding vascular structures.
The paraganglioma receives numerous collaterals from the blood vessels with which it comes into contact. The number and size of these collaterals are extremely variable while their position, even if variable, can generally be predicted. To reduce the possibility of hypertensive crisis during manipulation, a meticulous research and ligation of these collaterals must be performed during the operation.
When planning the intervention, the surgeon should focus not only on the lesion to be removed, but above all on its location in relation to the blood vessels, providing a personalized approach. It is of fundamental importance for the surgeon to study the radiological images well and perform reconstructions, if possible.
Moreover, performing the ultrasound examination of her/his patient, can help the surgeon build a mental image of the operation: in this regard, seemy post dedicated to ultrasonogrfy and the surgeon..
On Websurg, the website of the online University of IRCAD in Strasbourg, I have published two works that exemplify the above ideas:
English 
Italian