gms | German Medical Science

Objective: Preoperative embolization and interdisciplinary microsurgical resection are the preferred treatment for selected patients with large TJP due to high tumor control rates and good long-term results.

Methods: Preoperative embolization was performed in 15 cases. Radical tumor removal was possible in 12 patients. Hearing was preserved in four patients with normal preoperative audiogram. The facial nerve was preserved in all patients without preoperative deficits. Temporary facial nerve palsy occurred in two patients and resolved in long-term follow up. In three patients, preexisting facial nerve palsy remained unchanged. Persistent vocal cord palsy was present in three patients and was treated with laryngoplasty. The global recovery, based on the Karnofsky performance scale, was 100 % in 10 patients and 90% in 6 patients.

Results: Out of 64 patients with skull-base paraganglioma, 16 presented with large TJP (Fisch grade C and D). Posterior fossa involvement was present in 12 patients (Fisch D). Twelve patients presented with hearing loss, two patients with mild facial nerve palsy and two patients with additionally lower cranial nerve deficits. Two other patients with previous surgery presented with tumor regrowth.

Conclusion: Tympanojugular paraganglioma (TJP) are benign high-vascularized lesions located in the jugular foramen with frequent invasion to the temporal bone, the upper neck and the posterior fossa cavity. Their natural history, surgical treatment, and outcome have been well addressed in the recent literature. However there is no consensus regarding the optimal management especially in large TJP while minimizing treatment-related morbidity. In this study we assessed the interdisciplinary microsurgical treatment and outcome of large TJP collected at a single center.