Clinical Features and Surgical Outcomes of Jugulotympanic Paraganglioma.

Abstract

Introduction: Jugulotympanic paraganglioma (JTP) refers to paraganglioma arising from jugular bulb, which can invade surrounding structures such as the bones, blood vessels, meninges, and cranial nerves. The authors conducted a study to find surgical indications to avoid a serious cranial nerve complications by analyzing the medical records of patients who underwent surgical management for JTP.

Methods: We performed a single-institution, retrospective review of patients who underwent resection of JTP from 2004 to 2022. Patients underwent either Fisch infratemporal fossa approach type A (ITFA-A) or modification of ITFA-A with partial rerouting of the facial nerve. Preoperative and postoperative lower cranial nerve (LCN) function and facial function using the House-Brackmann (H-B) grade were evaluated.

Results: The study included 19 patients with a mean age of 43.1 years (standard deviation [SD], 16.1 years). The average tumor size was 28.6 mm (SD 12.6 mm). In patients with Fisch classes C1 and C2 tumors, there were 3 and 11 patients, respectively. Gross total tumor removal (GTR) was performed in all patients with classes C1 and C2. GTR was achieved in 2 out of the 5 patients with class C3 tumor. Seventeen patients underwent ITFA-A and 2 patients underwent partial rerouting. Facial function before surgery was normal in all but 3 cases. Among 16 patients with preoperative normal facial function, 13 had H-B grade I to II and 3 had H-B grade III at 1 year after surgery. Total and partial rerouting did not significantly affect facial function immediately after surgery or at the postoperative 1-year evaluation (p = 1.00). Preoperative LCN function was normal in all patients. LCN palsy lasting more than 1 year occurred in 7 patients after surgery. Patients with Fisch class C1 tumor did not develop postoperative LCN palsy. Among the patients with class C2 tumor, none of 5 patients with medial invasion depth less than 9.5 mm developed LCN palsy, whereas 5 of 6 patients (83.3%) with invasion depth of 9.5 mm or greater developed LCN palsy (p = 0.02).

Conclusion: JTPs with deep medial invasion should be managed conservatively to prevent LCN palsy.