title: Surgical management of giant transdural glomus jugulare tumors with cerebellar and brainstem compression.
abstract: Objective The objective of this study is to discuss the management of advanced glomus jugulare tumors (GJTs) presenting with intradural disease and concurrent brainstem compression. Study Design This is a retrospective case series. Results Over the last decade, four patients presented to our institution with large (Fisch D2; Glasscock-Jackson 4) primary or recurrent GJTs resulting in brainstem compression of varying severities. All patients underwent surgical resection through a transtemporal, transcervical approach resulting in adequate brainstem decompression; the average operative time was 12.75 hours and the estimated blood loss was 2.7 L. All four patients received postoperative adjuvant radiotherapy in the form of intensity-modulated radiation therapy or stereotactic radiosurgery. Combined modality treatment permitted tumor control in all patients (range of follow-up 5 to 9 years). Conclusion A small subset of GJTs may present with intracranial transdural extension with aggressive brainstem compression mandating surgical intervention. Surgical resection is extremely challenging; the surgical team must be prepared for extensive operating time and the patient for prolonged aggressive rehabilitation. Newly diagnosed and recurrent large GJTs involving the brainstem may be controlled with a combination of aggressive surgical resection and postoperative radiation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Colin L W
authors.initials: CL
authors.lastname: Driscoll
authors.forename: Joaquin J
authors.initials: JJ
authors.lastname: Garcia
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Janus
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
keywords: glomus jugulare; lateral skull base; paraganglioma