CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 04): S382-S384
DOI: 10.1055/s-0039-1695057
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Extradural Transjugular Transsigmoid Approach with High Cervical Exposure for Glomus Jugulare Tumor

1  Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
,
Michihiro Kohno
1  Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
,
Takao Hashimoto
1  Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
,
Hitoshi Izawa
1  Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
,
Yujiro Tanaka
1  Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
,
Taro Inagaki
2  Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

01 March 2019

09 July 2019

Publication Date:
03 October 2019 (online)

Abstract

Surgical removal of glomus jugulare tumors is challenging owing to the complex anatomy of the temporal bone and craniocervical region, aggressive tumor invasion into the nearby structures, and their hypervascularity. However, recent advances in skull base techniques, intraoperative neuromonitoring, and radiological interventions have enabled their relatively safe resection, while giving priority to functional preservation. This video demonstrates a case of a glomus jugulare tumor treated by the extradural transjugular transsigmoid approach with high-cervical exposure and tympamoplasty, after preoperative embolization. A 47-year-old woman presented with progressive hearing disturbance, pulsatile tinnitus, and hemifacial spasm. Neuroimaging displayed a hypervascular tumor occupying the temporal bone, extending to the cervical region through the jugular foramen, and to the external auditory canal. Preoperative feeder occlusion was successfully performed without any additional symptoms, while carefully evaluating the provocative test. Near-total resection of the tumor was achieved through the transjugular transsigmoid approach with high-cervical exposure under detailed neuromonitoring, including continuous facial nerve monitoring and auditory brainstem response. In this patient, in whom the tumor did not invade intradurally and the sigmoid sinus was already occluded preoperatively, the sinus was managed only by coagulation, to avoid unnecessary dural opening and the risk of cerebrospinal fluid leakage. Anterior facial nerve rerouting was not required since the tumor removal was accomplished through the corridor above and below the fallopian bridge. The patient had no new neurological deficits, and her pulsatile tinnitus and hemifacial spasm disappeared after the surgery. Her hearing disturbance improved postoperatively.

The link to the video can be found at: https://youtu.be/gqf3dxHlv_0.