gms | German Medical Science

Objective: Glomus jugulare tumors are benign high vascularised lesions located in the jugular foramen with frequent invasion to the middle ear, the upper neck, the temporal bone including the petrous apex and the posterior fossa cavitiy. Their natural history, surgical treatment, and outcome have been well addressed in the recent literature. The objective of this study was to analyze the interdisciplinary surgical treatment and outcome of large Gloums jugulare tumors collected at a single centre.

Methods: Out of 54 patients with paraganglioma 14 presented with Glomus jugulare tumors Fisch Class C and D. Eight patients presented with hearing loss, two patients with lower cranial nerve deficits and one patient with facial nerve palsy. Two other patients with previous surgery presented with tumor regrowth.

Results: Preoperative embolization was performed in 13 cases. Radical tumor removal through a combined presigmoidal infralabyrinthine and lateral suboccipital approach without rerouting of the facial nerve was possible in 10 patients. The lower cranial nerve function declined in two patients and other two had a new deficit. The resulting unilateral laryngeal palsy was treated with Vox implants. In both patients with secondary surgery the preexisting facial nerve palsy remained unchanged. In one patient with preoperative facial nerve palsy the tumor invaded the nerve. Otherwise, the facial nerve was preserved in all patients with primary surgery. Altogether in two patients reconstructive surgery for chronic facial nerve palsy was performed.

Conclusion: Despite the challenges in management of complex glomus jugulare tumors, interdisciplinary treatment including preoperative embolization, surgical resection and reconstructive surgery remains indicated and successful.

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