Surgical Management of Class C and D Glomus Jugulare Tumors: Fisch Infratemporal Fossa Type A Approach

Objective: To analyze retrospectively the indications and the results obtained with the Fisch infratemporal fossa Type A approach in a series of patients with Class C and D glomus jugulare tumors.

Methods: The study included 39 patients admitted to our hospital from July 2007 to July 2019 with Class C and D glomus jugulare tumors that were removed with the Fisch infratemporal fossa Type A approach. All patients underwent preoperative pure-tone audiometry, evaluation of facial function, CT and MR imaging, and digital subtraction angiography (DSA). Fourteen males (35.8%) and 25 females (64.2%), with an average age of 42.7 years, were analyzed.

Results: Thirty-six cases (92.3%) presented pulsatile tinnitus and hearing loss as the main symptoms. According to the Fisch classification 1981, the tumors in 31 ears were class C, and Class D in 8 ears. The tumor was totally removed in 37 (94.9%) and near-totally removed in 2 (5.1%) of the patients. The facial nerve was permanently anteriorly transposed in 36 (92.3%) of the patients. The postoperative facial function after 6 weeks was House-Brackmann grade ? in 8 (20.5%), grade ? in 16 (41.0%), grade ? in 9 (23.1%), grade ? in 4 (10.3%), grade ? in 2 (5.1%) patients. There were two patients who required revision surgery, one with a CSF leak and another with a postoperative tumor recurrence. Dysphagia and hoarseness were seen in three cases, respectively. There were no deaths and no severe complications such as hemiplegia or intracranial infections. Of the 39 patients followed up with a mean time of 5.9 years (range: 0.2–12.1 years).

Conclusion: Fisch infratemporal fossa Type A approach allows complete resection of the tumor. Surgical approach can supply a wide exposure of surgical field and make the surgeon to protect the large blood vessels and nerve, which leads to low rates of complications.