Less invasive transjugular approach with Fallopian bridge technique for facial nerve protection and hearing preservation in surgery of glomus jugulare tumors

Abstract

For the past three decades, surgery of glomus jugulare tumors (GJTs) has been characterized by extensive combined head and neck, neuro-otologic, and neurosurgical approaches. In recent years, the authors have modified the operative technique to a less invasive approach for preservation of cranial nerves while achieving satisfactory tumor resection. We evaluated and compared the clinical outcomes of our current less invasive approach with our previous more extensive procedures. The clinical records of 39 cases of GJT surgically treated between 1992 and 2011 were retrospectively reviewed. The less invasive transjugular approach with Fallopian bridge technique (LI-TJ) was used for the most recent five cases. The combined transmastoid-transjugular and high cervical (TM-HC) approach was performed in 30 cases, while four cases were treated with a transmastoid-transsigmoid approach with facial nerve translocation. Operative technique, extent of tumor resection, operating time, hospital stay, and morbidity were examined through the operative records, and a comparison was made between the LI-TJ cases and the more invasive cases. No facial nerve palsy was seen in the LI-TJ group while the TM-HC group demonstrated six cases (17.6%) of facial palsy (House-Brackmann facial nerve function grading scale grade II and III). The complication rate was 0 % in the LI-TJ group and 16.7% in the more invasive group. The mean operative time and hospital stay were shorter in the LI-TJ group (6.4 h and 4.3 days, respectively) compared with the more invasive group (10.7 h and 8.0 days, respectively). The LI-TJ approach with Fallopian bridge technique provided adequate tumor resection with cranial preservation and definitive advantage over the more extensive approach.

Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective

“…2,42,43 The distribution of Fisch classifications varied among studies and disciplines. Reported Type Di2 lesions accounted for only 2.9%-7.7%, 9,41,55 or 25.9% 32 in a recent large otolaryngological study, which was significantly lower than other neurological studies (38.2%) 2 and our own findings (47.1%). If intracranial extension was involved, the percentage of lesions classified as Fisch Type D was calculated as 18.7% in 530 lesions, 21 and our value (84.3%) was also higher than in other studies (range 33%-72%).…”

“…4,52 Except for these aforementioned conservative approaches, surgical treatment had been confirmed to be a definitive and convincing strategy that offers the only chance of a cure. 9,19,[22][23][24][25][26]28,32,41,48,52,55 In our hospital, the aim of surgery was the maximal elimination of JFPs and the preservation of neurological function. A GTR was an ideal tactic that was attempted, with accompanying morbidity; meanwhile, STR plus radiotherapy was a second option with relatively low functional impairment.…”

“…3,38 The majority of JFPs were treated and reported by otolaryngology-head and neck surgeons, [4][5][6]10,11,[16][17][18][19]28,30,32,40,[49][50][51][52]55,56 but relatively few by neurosurgeons. 1,2,31,35,41,43 Often JFPs were reported together with glomus tumors of other regions and, less frequently, with subdural invasion, 49,50 although JFPs are inherently distinct from other glomus tumors in terms of surgical difficulty and outcomes. In the present study, we reviewed our less-aggressive treatment strategy and neurosurgical experience in JFPs to achieve satisfactory neurological outcome.…”

Results of a systematic literature review of treatment modalities for jugulotympanic paraganglioma, stratified per Fisch class

“…Obviously, the risk associated with surgery of Fisch class C and D tumours is dependent on multiple factors, one of the most important ones being the expertise of the centre. Nevertheless, when considering the large series (N > 30) published by expertise‐centres, higher cranial nerve damage and complication rates post‐surgery and lower local control rates remain when compared to radiotherapy series . It seems as if high local control rates come at the cost of high morbidity rates and vice versa.…”

Japanese Neurosurgeons and Microsurgical Anatomy: A Historical Review

“…To date, 11 Japanese neurosurgeons have published 30 original papers in English as first authors and 9 of these are concerned solely or mainly with microsurgical anatomy. 84–92) They also published the Fukushima Manual of Skull Base Dissection, which was originally used during his dissection course. 93) Some of his students published textbooks on skull base dissection.…”