title: Microsurgical treatment of large and giant tympanojugular paragangliomas.
abstract: BACKGROUND
  Tympanojugular paragangliomas (TJPs) are benign, highly vascularized lesions located in the jugular foramen with frequent invasion to the temporal bone, the upper neck, and the posterior fossa cavity. Their natural history, surgical treatment, and outcome have been well addressed in the recent literature; however, there is no consensus regarding the optimal management while minimizing treatment-related morbidity. In this study, we assessed the interdisciplinary microsurgical treatment and outcome of large TJP collected at a single center.
  
  
  METHODS
  Out of 54 patients with skull base paraganglioma, 14 (25%) presented with large TJP (Fisch grade C and D). Posterior fossa involvement was present in 10 patients (Fisch D). Eleven patients presented with hearing loss, two patients with mild facial nerve palsy, and two patients with lower cranial nerve deficits. Two other patients with previous surgery presented with tumor regrowth.
  
  
  RESULTS
  Preoperative embolization was performed in 13 cases. Radical tumor removal was possible in 10 patients. Hearing was preserved in four patients with normal preoperative audiogram. The facial nerve was preserved in all patients. Temporary facial nerve palsy occurred in two patients and resolved in long-term follow-up. In three patients, preexisting facial nerve palsy remained unchanged. Persistent vocal cord palsy was present in three patients and was treated with laryngoplasty. The global recovery based on the Karnofsky performance scale was 100% in 10 patients and 90% in 4 patients.
  
  
  CONCLUSIONS
  Preoperative embolization and interdisciplinary microsurgical resection are the preferred treatment for selected patients due to high tumor control rates and good long-term results.
authors.affiliation: Department of Neurosurgery, Klinikum Dortmund, Münsterstrasse 241, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Harati
authors.affiliation: Department for Head and Neck Surgery, Klinikum Dortmund, Beurhausstrasse 40, Dortmund, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deitmer
authors.affiliation: Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, Dortmund, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rohde
authors.affiliation: Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, Dortmund, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ranft
authors.affiliation: Department of Radiology and Neuroradiology, Knappschaftskrankenhaus Bochum Langendreer, Ruhr-University Bochum, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Weber
authors.affiliation: Department of Neurosurgery, Klinikum Dortmund, Münsterstrasse 241, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Schultheiß
keywords: Embolization; glomus jugulare tumors; jugular foramen; microsurgery; tympanojugular paraganglioma