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.
Keywords
head and neck - infralabyrinthine approach - infratemporal fossa - jugulotympanic
paraganglioma - postauricular transtemporal
