Rubens de Brito1, Juan Carlos Cisneros Lesser2,3, Paula Tardim Lopes1, Ricardo Ferreira Bento1. 1. Otorhinolaryngology and Neurotology, Health Science, Hospital das Clínicas, Otorhinolaryngology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 6th floor, room 6167, São Paulo, 05403-000, Brazil. 2. Otorhinolaryngology and Neurotology, Health Science, Hospital das Clínicas, Otorhinolaryngology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 6th floor, room 6167, São Paulo, 05403-000, Brazil. juancarloscisneros@me.com. 3. National Institute of Rehabilitation, Mexico City, Mexico. juancarloscisneros@me.com.
Abstract
PURPOSE: To describe the neurological results obtained in six patients with large Fisch C glomus jugulare tumors (GJT) in which a less aggressive, nerve-preserving surgical strategy was used to reduce surgical morbidity. METHODS: Prospective study of six patients with Fisch C GJT who underwent surgery in a tertiary care referral center from February 2015 to August 2017 with an average follow-up of 18 months. The intervention is the surgical technique used and the main outcome measures are recurrence and the functional preservation of the facial and lower cranial nerves. RESULTS: Gross total removal was obtained in the six patients with preservation of the medial wall of the jugular bulb protecting the lower cranial nerves. After follow-up, we obtained a House-Brackmann (H-B) grade II in three patients who were managed with an inferior facial nerve transposition. One patient managed with a facial bridge technique preserved a normal facial function and two patients who presented a H-B III before surgery went to H-B V after surgery and recovered to a H-B III after 4 months. Four patients were presented with dysphagia after surgery and required nasogastric tube placement. The average time for removal with return to normal oral feeding was 4.3 weeks. Three patients with preoperative Xth nerve dysfunction showed an adequate compensation of the opposite vocal fold in the postoperative period without dysphonia or aspiration. CONCLUSION: The surgical techniques used in these patients provided good functional preservation without recurrence after an 8-30-month follow-up.
PURPOSE: To describe the neurological results obtained in six patients with large Fisch C glomus jugulare tumors (GJT) in which a less aggressive, nerve-preserving surgical strategy was used to reduce surgical morbidity. METHODS: Prospective study of six patients with Fisch C GJT who underwent surgery in a tertiary care referral center from February 2015 to August 2017 with an average follow-up of 18 months. The intervention is the surgical technique used and the main outcome measures are recurrence and the functional preservation of the facial and lower cranial nerves. RESULTS: Gross total removal was obtained in the six patients with preservation of the medial wall of the jugular bulb protecting the lower cranial nerves. After follow-up, we obtained a House-Brackmann (H-B) grade II in three patients who were managed with an inferior facial nerve transposition. One patient managed with a facial bridge technique preserved a normal facial function and two patients who presented a H-B III before surgery went to H-B V after surgery and recovered to a H-B III after 4 months. Four patients were presented with dysphagia after surgery and required nasogastric tube placement. The average time for removal with return to normal oral feeding was 4.3 weeks. Three patients with preoperative Xth nerve dysfunction showed an adequate compensation of the opposite vocal fold in the postoperative period without dysphonia or aspiration. CONCLUSION: The surgical techniques used in these patients provided good functional preservation without recurrence after an 8-30-month follow-up.
Entities:
Keywords:
Glomus jugulare tumor; Infratemporal approach; Paraganglioma; Skull base tumor
Authors: Luis A B Borba; João Cândido Araújo; Jean G de Oliveira; Miguel Giudicissi Filho; Marlus S Moro; Luis Fernando Tirapelli; Benedicto O Colli Journal: J Neurosurg Date: 2010-01 Impact factor: 5.115