Transmastoid-Infralabyrinthine Tailored Surgery of Jugular Paragangliomas

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