ABSTRACT
This article presents our experience with the management and outcomes of patients with sporadic glomus jugular tumors using a tailored surgical approach. We conducted a retrospective study of 49 patients with sporadic jugular paragangliomas. Thirty-eight patients (78%) were treated using the transmastoid-infralabyrinthine (TM-IL) approach, and 11 (22%) were treated with the infratemporal fossa type A (IFT-A) approach. Mean follow-up period was 8.2 years. Surgical cure was achieved in all but 6 patients using the TM-IL approach (84%) and in 8 of 11 patients with the IFT-A approach (73%). A House-Brackmann grade of I or II facial nerve function was obtained postoperatively in 84% of TM-IL cases and in 56% of the IFT-A cases. The incidence of other complications—meningitis and transient cerebrospinal fluid leak—was higher in the TM-IL group (8% and 13%, respectively) compared with the IFT-A group (0% and 9%, respectively). We concluded that the TM-IL approach with individually tailored management of the facial nerve fulfills the long-term requirements of both keeping good postoperative facial function and obtaining adequate tumor resection.
KEYWORDS
Jugular paraganglioma - surgery - facial nerve - transmastoid-infralabyrinthine approach - infratemporal fossa approach
REFERENCES
-
1 Fisch U. Infratemporal fossa approach for extensive tumors of the temporal bone and base of the skull. In: Silverstein H, Norrel H Neurological Surgery of the Ear. Birmingham, AL; Aesculapius 1977: 34-53
-
2
Briner H R, Linder T E, Pauw B, Fisch U.
Long-term results of surgery for temporal bone paragangliomas.
Laryngoscope.
1999;
109
577-583
-
3
Sanna M, Jain Y, De Donato G et al..
Management of jugular paragangliomas: the Gruppo Otologico experience.
Otol Neurotol.
2004;
25
797-804
-
4
Glasscock III M E, Harris P F, Newsome G.
Glomus tumors: diagnosis and treatment.
Laryngoscope.
1974;
84
2006-2032
-
5
Farrior J B.
Anterior hypotympanic approach for glomus tumor of the infratemporal fossa.
Laryngoscope.
1984;
94
1016-1021
-
6
Brackmann D E.
The facial nerve in the infratemporal approach.
Otolaryngol Head Neck Surg.
1987;
97
15-17
-
7
Maniglia A J, Sprecher R C, Megerian C A, Lanzieri C.
Inferior mastoidectomy-hypotympanic approach for surgical removal of glomus jugulare tumors: an anatomical and radiologic study emphasizing distances between critical structures.
Laryngoscope.
1992;
102
407-414
-
8
Martin C, Prades J M.
Removal of selected infralabyrinthine lesions without facial nerve mobilization.
Skull Base Surg.
1992;
2
220-226
-
9
Jackson C G.
The infratympanic extended facial recess approach for anteriorly extensive middle ear disease: a conservation technique.
Laryngoscope.
1993;
103
451-454
-
10
George B, Lot G, Tran Ba Huy P.
The juxtacondylar approach to the jugular foramen (without petrous drilling).
Surg Neurol.
1995;
44
279-284
-
11
Pensak M L, Jackler R K.
Removal of jugular foramen tumors: the fallopian bridge technique.
Otolaryngol Head Neck Surg.
1997;
117
586-591
-
12
Leonetti J P, Brackmann D E, Prass R L.
Improved preservation of facial nerve function in the intratemporal approach to the skull base.
Otolaryngol Head Neck Surg.
1989;
101
74-78
-
13
Jackson C G.
Glomus tympanicum and glomus jugulare tumors.
Otolaryngol Clin North Am.
2001;
34
941-970
-
14
Jackson C G, McGrew B M, Forest J A, Netterville J L, Hampf C F, Glasscock III M E.
Lateral skull base surgery for glomus tumors: long-term control.
Otol Neurotol.
2001;
22
377-382
-
15
Borba L A, Ale-Bark S, London C.
Surgical treatment of glomus jugulare tumors without rerouting of the facial nerve: an infralabyrinthine approach.
Neurosurg Focus.
2004;
17
E8
-
16
Gjuric M, Wolf S R, Wigand M E.
Cranial nerve and hearing function after combined-approach surgery for glomus jugulare tumors.
Ann Otol Rhinol Laryngol.
1996;
105
949-954
-
17
Gjuric M, Seidinger L, Wigand M E.
Long-term results of surgery for temporal bone paraganglioma.
Skull Base Surg.
1996;
6
147-152
-
18
Gjuric M, Wigand M E, Weidenbecher M, Wolf S R, Seidinger L.
Function preserving surgery of glomus jugulare tumors: an achievable goal?.
HNO.
1997;
45(12)
983-989
-
19 Fisch U, Mattox D. Microsurgery of the Skull Base. Stuttgart; Thieme 1988
-
20
Greess H, Bentzien S, Gjuric M, Lell M, Lenz M, Bautz W.
Diagnosis of glomus jugulare tumor recurrence with dynamic contrast medium flow in MRI.
Rofo.
2000;
172
753-758
-
21
House J W, Brackmann D E.
Facial nerve grading system.
Otolaryngol Head Neck Surg.
1985;
93
146-147
-
22
Fisch U, Pillsbury H C.
Infratemporal fossa approach to lesions in the temporal bone and base of the skull.
Arch Otolaryngol.
1979;
105
99-107
-
23
Capps F CW.
Glomus jugulare tumours of the middle ear.
J Laryngol Otol.
1952;
66
302-314
-
24
Shapiro M J, Neues D K.
Technique for removal of glomus jugulare tumors.
Arch Otolaryngol.
1964;
79
219-224
-
25
Hilding D A, Greenberg A.
Surgery for large glomus jugulare tumor.
Arch Otolaryngol.
1971;
93
227-231
-
26
Parhizkar N, Hiltzik D H, Selesnick S H.
Facial nerve rerouting in skull base surgery.
Otolaryngol Clin North Am.
2005;
38
685-710
-
27
Selesnick S H, Abraham M T, Carew J F.
Rerouting of the intratemporal facial nerve: an analysis of the literature.
Am J Otol.
1996;
17
793-805
-
28
Ramina R, Maniglia J J, Fernandes Y B et al..
Jugular foramen tumors: diagnosis and treatment.
Neurosurg Focus.
2004;
17
E5
Mislav GjuricM.D.
Kozarceva 18a
HR-10000 Zagreb, Croatia
Email: mislav.gjuric@zg.t-com.hr
