Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases

Abstract

Jugular foramen paragangliomas are rare skull base tumours posing multiple complex diagnostic and management problems. We did a study to evaluate surgical technique, outcome and complications in 75 cases of tumours treated by multidisciplinary approach (i.e. combined neurosurgery, neuroradiology, ear, nose and throat surgery and intensive care unit team). Retrospective study on 75 consecutive patients with jugular foramen paragangliomas treated surgically from 1989 to 2005. Preoperative balloon occlusion test was performed in all patients as well as embolization (100%). A combined limited infratemporal and juxtacondylar approach was used in all patients. Gross total resection was achieved in 59 patients (78.7%). The most common complication was represented by lower cranial nerve deficits in five patients (6.6%), which was only temporary in three. Postoperative facial nerve weakness occurred in five cases (6.6%) and resolved in three of them. The remaining two patients underwent facial nerve reconstruction by hypoglossal/facial nerve anastomosis. Four patients (5.3%) had a postoperative cerebrospinal fluid leak, which was successfully treated by lumbar drainage. Two patients (2.7%) died because of complications related to surgical injury of lower cranial nerves: one patient developed aspiration pneumonia and septicemia and the second one developed a large cervico-bulbar hematoma that led to severe respiratory distress and ultimately global cerebral hypoxia. Paragangliomas are rare and complex skull base lesions that may be managed with low morbidity and mortality if a multidisciplinary approach is considered. Facial and lower cranial nerve postoperative deficits can be limited.

Gamma Knife radiosurgery for glomus tumors: Long‐term results in a series of 30 patients

“…[6][7][8][9]12,13,18,19,[24][25][26] Glomus tumors treatment has gradually shifted to a multimodal approach through the use of radiation techniques, addressing surgery to symptomatic patient with intracranial hypertension or brainstem compression. [6][7][8][9]12,13,18,19,[24][25][26] Glomus tumors treatment has gradually shifted to a multimodal approach through the use of radiation techniques, addressing surgery to symptomatic patient with intracranial hypertension or brainstem compression.…”

“…Surgery has represented the mainstay of glomus tumors treatment, nevertheless despite the progresses in microsurgery, the actuarial rate of gross-total resection is still low if compared to other benign skull base lesions, with a high risk of surgery-related morbidity and mortality. [6][7][8][9]12,13,18,19,[24][25][26] Glomus tumors treatment has gradually shifted to a multimodal approach through the use of radiation techniques, addressing surgery to symptomatic patient with intracranial hypertension or brainstem compression. 6,13,24 RT showed good tumor control rates with lower morbidity when compared to surgical resection, however, the inaccurate target dose delivery is related to some long-term adverse effects, such as xerostomia and new CNs deficits, dermal reactions, radiation-induced malignancies, temporal bone osteonecrosis, and radionecrosis.…”

“…12,13 The surgical mortality rate ranges from 2.6% to 13% in the pertinent literature, while the rate of cranial nerve (CN) injury ranges from 18.7% to 44% depending on the series. 12,13,18 Endovascular embolization of feeding vessels from the ascending pharyngeal artery has been adopted to reduce intraoperative bleeding during tumor resection. 7,8,19 Radiation therapy (RT), and more recently fractionated-RT, has been also considered in the treatment algorithm of glomus tumors with acceptable tumor control, nevertheless the patients may be exposed to the risk of radiation-related long-term complications.…”

Intracranial Pressure and the Role of the Vagus Nerve: A Hypothesis

“…Bearing in mind that structure often defines function, why does the vagus nerve lie subendothelially in the jugular foramen, the leading exit of the cerebral venous system? In the advential layer of the jugular bulb there is a lining of nonchromaffin-staining paraganglian cells that make nerve connections with the glossopharyngeal and vagus nerves [15]. These cells have a well-defined chemoreceptor function [16].…”

Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery

“…Gross resection has been the mainstay of therapy but can be complicated by cranial neuropathies and significant surgical blood loss. 3–6 Embolization is frequently utilized to minimize intra-operative blood loss. Multi-modality therapy combining subtotal resection with various forms of radiotherapy has been shown to be effective at controlling tumor growth; however, surgical and radiation-induced complications still exist.…”