Surgical management of tympanojugular paragangliomas with intradural extension, with a proposed revision of the fisch classification
Background: Tympanojugular paragangliomas (TJPs) with intradural extension can be successfully treated by a single or staged procedure with low surgical morbidity. Objectives: To present the clinical findings and treatment methods used for surgically treating TJP with intradural extension, as...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Karger AG, Basel
2012
|
| Subjects: | |
| Online Access: | http://irep.iium.edu.my/24136/ http://irep.iium.edu.my/24136/ http://irep.iium.edu.my/24136/ http://irep.iium.edu.my/24136/1/Surgical_Management_of_Tympanojugular_Paragangliomas_with_Intradural_Extension%2C_with_a_Proposed_Revision_of_the_Fisch_Classification.Audiol_%26_Neurotol.pdf |
| Summary: | Background: Tympanojugular paragangliomas (TJPs) with
intradural extension can be successfully treated by a single
or staged procedure with low surgical morbidity.
Objectives: To present the clinical findings and treatment methods
used for surgically treating TJP with intradural extension,
as well as to discuss the complications of treatment and the
relative merits of single versus staged surgery by using a
comprehensive literature review comparing objective outcome
measures.
Study Design: A retrospective case review
of 45 cases of TJP with intradural extension.
Setting: A quaternary skull base and neurotologic center.
Materials and Methods: The charts of 45 patients with Fisch classification
class C or D TJP with intradural extension, who were operated
on from April 1988 to April 2010, were analyzed. Clinical
findings and preoperative lower cranial nerve (LCN) palsy as
well as postoperative totality of resection, postoperative
LCN palsy and complications were studied. The types, indications,
and distribution of staged procedures were also analyzed.
Results: Out of 45 cases, 22 were C3di2. The IX and X
cranial nerves were the commonest nerves affected preoperatively.
Preoperative internal carotid artery management
was performed in 16 cases. Twenty-nine cases had a single
procedure and 16 had a staged procedure. The main indication
for staged procedures was intradural extension of 2 cm
or more. The infratemporal fossa approach (ITFA) type A was
the main procedure in all cases. Overall, total resection was
achieved in 68.8% of cases with postoperative cerebrospinal
fluid leak in 4.4% cases. Postoperative House-Beckmann
grade I–III facial nerve status was maintained in 80% of cases,
and overall LCN preservation rate was 56.9%. There were no
cases requiring tracheostomy, and 3 cases required delayed
phonosurgical procedures to improve their voice.
Conclusions: TJP with intradural extension can be successfully managed
with the judicious use of staged procedures to reduce
the incidence of postoperative cerebrospinal fluid leak. The
ITFA did not cause an excessively high rate of facial nerve
palsy, and the overall total resection and LCN preservation
rate compares very favorably with previously published
data. |
|---|