Management of Facial Nerve in Surgical Treatment of Previously Untreated Fisch Class C Tympanojugular Paragangliomas: Long-Term Results

Abstract

The aim of this study was to evaluate the long-term facial nerve outcome according to management of the facial nerve in patients undergoing surgery for Fisch class C tympanojugular paragangliomas. The study population consisted of 122 patients. The infratemporal type A approach was the most common surgical procedure. The facial nerve was left in place in 2 (1.6%) of the 122 patients, anteriorly rerouted in 97 (79.5%), anteriorly rerouted with segmental resection of the epineurium in 7 (5.7%), and sacrificed and reconstructed in 15 (12.3%). One patient underwent cross-face nerve grafting. At last follow-up, House-Brackmann grade I to II was achieved in 51.5% of patients who underwent anterior rerouting and in 28.5% of those who underwent anterior rerouting with resection of the epineurium. A House-Brackmann grade III was achieved in 73.3% of patients who underwent cable nerve graft interposition. The two patients in whom the facial nerve was left in place experienced grade I and grade III, respectively. The patient who underwent cross-face nerve grafting had grade III. Gross total resection was achieved in 105 cases (86%). Management of the facial nerve in tympanojugular paraganglioma surgery can be expected to ensure satisfactory facial function long-term outcome.

Multidisciplinary Management of Lateral Skull Base Paragangliomas: A 20-Year Experience

“…This is potentially due the knowledge that treatment of Fisch C/D tumors is known to more likely result in significant posttreatment morbidity such as a facial nerve palsy. 6,19 With a recent recognition that the majority of lateral skull base paragangliomas are slow growing, there has been a shift in recent years toward an initial watch and wait approach, particularly for Fisch C and D tumors. 6,18 However, in the literature, it is estimated that almost one-third of observed lateral skull base paragangliomas will grow significantly, leading to worsening symptoms or cranial neuropathies.…”

“…This is consistent with available literature, suggesting that cranial neuropathy is a frequent complication of surgical resection for lateral skull base paragangliomas. 19,22 Notably, all patients (n ¼ 4) with secretory tumors underwent surgical removal of disease as is necessary to eliminate the symptoms of catecholamine excess. Irrespective of treatment strategy, 12 patients (12/57, 21.1%) required rescue treatment in our cohort due to recurrent or residual disease.…”

“…Notably a higher proportion of patients advised to undergo an active surveillance strategy had Fisch C/D tumours (10/13, 76.9%) although this did not reach statistical significance (p=0.22). This is potentially due the knowledge that treatment of Fisch C/D tumours is known to more likely result in significant post treatment morbidity such as a facial nerve palsy [6,19]. With a recent recognition that the majority of lateral skull base paragangliomas are slow growing there has been a shift in recent years towards an initial watch and wait approach, particularly for Fisch C and D tumours [6,18].…”

“…resection for lateral skull base paragangliomas [19,22]. Notably, all patients (n=4) with secretory tumours underwent surgical removal of disease as is necessary to eliminate the symptoms of catecholamine excess.…”