title: Less invasive transjugular approach with Fallopian bridge technique for facial nerve protection and hearing preservation in surgery of glomus jugulare tumors.
abstract: For the past three decades, surgery of glomus jugulare tumors (GJTs) has been characterized by extensive combined head and neck, neuro-otologic, and neurosurgical approaches. In recent years, the authors have modified the operative technique to a less invasive approach for preservation of cranial nerves while achieving satisfactory tumor resection. We evaluated and compared the clinical outcomes of our current less invasive approach with our previous more extensive procedures. The clinical records of 39 cases of GJT surgically treated between 1992 and 2011 were retrospectively reviewed. The less invasive transjugular approach with Fallopian bridge technique (LI-TJ) was used for the most recent five cases. The combined transmastoid-transjugular and high cervical (TM-HC) approach was performed in 30 cases, while four cases were treated with a transmastoid-transsigmoid approach with facial nerve translocation. Operative technique, extent of tumor resection, operating time, hospital stay, and morbidity were examined through the operative records, and a comparison was made between the LI-TJ cases and the more invasive cases. No facial nerve palsy was seen in the LI-TJ group while the TM-HC group demonstrated six cases (17.6%) of facial palsy (House-Brackmann facial nerve function grading scale grade II and III). The complication rate was 0 % in the LI-TJ group and 16.7% in the more invasive group. The mean operative time and hospital stay were shorter in the LI-TJ group (6.4 h and 4.3 days, respectively) compared with the more invasive group (10.7 h and 8.0 days, respectively). The LI-TJ approach with Fallopian bridge technique provided adequate tumor resection with cranial preservation and definitive advantage over the more extensive approach.
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, 1000 Trent Drive 4520 Hosp South, Durham, NC, 27710, USA, ynonaka1971@yahoo.co.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nonaka
authors.forename: Takanori
authors.initials: T
authors.lastname: Fukushima
authors.forename: Kentaro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
authors.forename: John T
authors.initials: JT
authors.lastname: McElveen
authors.forename: Calhoun D
authors.initials: CD
authors.lastname: Cunningham
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology; D002574:Cervical Vertebrae / Q000601:surgery; D003391:Cranial Nerves / Q000502:physiology; D005154:Facial Nerve / Q000033:anatomy & histology* / Q000473:pathology; D020220:Facial Nerve Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005925:Glomus Jugulare Tumor / Q000601:surgery*; D006311:Hearing Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016683:Supine Position; D016896:Treatment Outcome; D055815:Young Adult