Combined approach surgery for removal of glomus jugulare tumors

Gardner, Gale; Cocke, Edwin W.; Robertson, James T.; Trumbull, Merlin L.; Palmer, Robert E. A.

doi:10.1002/lary.5540870503

Cited by 102 publications

(37 citation statements)

References 31 publications

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“…This approach was being popularized for the resection of glomus jugulare tumors. 13,15,20 Hakuba and associates 16 reported their experience with the resection of 3 jugular foramen schwannomas in 1979. Gross-total resection was achieved in all patients.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system

Bulsara

Sameshima²,

Friedman

et al. 2008

JNS

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A dvAnces in microsurgical techniques and cranial base approaches have allowed access to areas of the brain once considered inaccessible. Despite these advances, however, the microsurgical resection of jugular foramen schwannomas continues to pose a formidable challenge. Fewer than 200 cases of schwannomas arising from the jugular foramen have been reported in the literature, a testament to the rarity of this tumor. 25,29,41,53,59,65,71,74 Experience has shown that the traditional suboccipital and transmastoid approaches do not provide adequate exposure of these lesions. Understanding and utilizing advanced skull base surgery techniques and concepts is essential for adequate resection of these tumors with CN preservation. We review the senior author's experience (T.F.) in the management of 53 jugular foramen schwannomas and propose a modified grading scheme to guide operative planning for these tumors. MethodsWe retrospectively reviewed all cases of jugular foramen schwannomas treated by the senior author Object. Due to the proximity and involvement of critical neurovascular structures, the resection of jugular foramen schwannomas can pose a formidable challenge. The authors review their experience in the microsurgical management of jugular foramen schwannomas and propose a modified grading scale to guide surgical management.Methods. All jugular foramen schwannoma cases treated by the senior author (T.F.) between 1980 and 2004 were retrospectively reviewed. The average age at presentation, surgical approach, tumor characteristics, cranial nerve (CN) deficits, and tumor recurrence rates were assessed. The authors present the following modified grading scale: Type A, intradural tumors; Type B, dumbbell-shaped tumors; and Type C, triple dumbbell tumors with a high cervical extension.Results. The authors treated jugular foramen tumors in 129 patients during the study period. Of these, 53 patients (41%) had jugular foramen schwannomas. The mean patient age was 52 years (range 14-74 years); there were 12 male and 41 female patients. The mean follow-up period was 8.4 years. Patients presented most commonly with deficits of the vagus nerve, followed by vestibular/cochlear nerve and glossopharyngeal nerve deficits. Gross-total resection of the tumor was achieved in 48 patients (90.5%). New postoperative paresis in a previously normal CN was not seen; however, worsening of preoperative CN deficits was frequently noted. The highest incidence occurred with the glossopharyngeal and vagus nerves (30%), with 26% of the deficits being permanent. There were no deaths related to surgery in this series. Three patients (5.7%) experienced tumor recurrence.Conclusions. The microsurgical resection of jugular foramen schwannomas carries a risk of worsening preoperative CN deficits; however, these are often transient. Based on their experience, the authors have formulated a grading scale that predicts the optimal surgical approach to these lesions. Considerable technical training and microneuroanatomical knowledge of the region is requi...

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Section: Discussionmentioning

confidence: 99%

Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system

Bulsara

Sameshima²,

Friedman

et al. 2008

JNS

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“…Gardner, et al 22 find the main trunk of the facial nerve by dissecting the tail of the parotid from its bed, partially detaching the sternocleidomastoid muscle, exposing the posterior belly of the digastric, and then identifying the nerve as it lies medial to this muscle. This technique may not be possible if tumor and/or previous surgery have distorted the stylomastoid foramen area.…”

Section: Discussionmentioning

confidence: 99%

The Stylomastoid Area: Anatomic‐Histologic Study and Surgical Approach

Holt

1996

The Laryngoscope

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This three-part study explored the difficult problem of dissecting the facial nerve through the soft tissues of the mastoid tip. The anatomic relationships of the mastoid tip tissues were measured in 20 specimens. At the stylomastoid foramen, the facial nerve lies an average of 9 mm from the digastric muscle, 11 mm from the external canal, and 21 mm from the nerve's parotid bifurcation. The histologic relationships between the nerve sheath and the mastoid tip fascial tissues were examined in 10 specimens. The tight adherence of sheath and fascial fibers prevent their easy separation. By applying this new anatomic and histologic knowledge on cadaver specimens, the author refined a technique for the safe dissection of the facial nerve through mastoid tip tissues. This technique has proven successful in the operating room.

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“…39,[52][53][54] The type A infratemporal fossa exposure described by Fisch and Mattox is best used for type C1 and C2 tumors. This approach provides wide exposure of the jugular bulb, proximal and distal vascular control of the jugular bulb, and exposure of the carotid canal to the horizontal segment.…”

Section: Skull Base Diseasesmentioning

confidence: 99%