Jugulotympanic paraganglioma, preoperative embolization, and transmastoid retrolabyrinthine approach: Two-dimensional operative video

Abstract

Background:

Jugulotympanic paraganglioma (JTP), also known as glomus jugulare tumor, is a neuroendocrine neoplasm. Although it represents <0.5% of head-and-neck tumors, it demonstrates significant local aggressiveness due to its tendency to infiltrate bone, vascular structures, and cranial nerves. Due to the hypervascular nature of these tumors, preoperative embolization has become an important surgical adjunct. The retrolabyrinthine approach provides adequate exposure of the jugular foramen while preserving the facial nerve without mandatory transposition.

Case Description:

We present a 52-year-old woman with hearing loss, tinnitus, and dizziness. Evaluation revealed left-sided anacusis secondary to prior cochlear dysfunction and severe conductive hearing loss. Computed tomography showed extensive erosion of the jugular foramen without carotid canal, labyrinth, or internal auditory canal involvement. Magnetic resonance imaging (MRI) demonstrated a Fisch D1 lesion with cisternal and extracranial extension, measured 30 × 18 × 22 mm along its craniocaudal, anteroposterior, and laterolateral axes, respectively, with an estimated volume of 5.94 cm³. After multidisciplinary discussion, preoperative embolization of external carotid branches achieved >50%, followed by a transmastoid retrolabyrinthine approach for resection. Estimated blood loss was 2500 mL. In the postoperative course, the patient had House–Brackmann grade I facial function, moderate dysphagia, and mild dysphonia. A 3-month postoperative MRI shows expected postoperative changes and no evidence of residual tumor.

Conclusion:

Preoperative embolization facilitates surgical resection in advanced JTP. Combined with meticulous technique and neuromonitoring, it enables favorable functional outcomes and cranial nerve preservation.

[Video 1]-Available on:

www.surgicalneurologyint.com

Annotations[1-10]

00:12 - Clinical presentation

01:05 - Neuroimaging findings

01:36 - Decision-making

02:27 - Risks of the procedure and its potential benefits

02:54 - Alternative treatment options and rationale for nonselection

03:28 - Endovascular angiography embolization

04:12 - Operative setup

04:41 - Exposure of Macewen’s suprameatal triangle

04:56 – Mastoidectomy

05:09 - Facial nerve neuromonitoring

05:16 - Posterior petrosectomy

05:38 - Extradural tumor resection

06:58 -Intradural tumor resection

07:40 - Temporalis fascia reconstruction

07:48 - Hemostasis and dural closure

08:01 - Temporalis muscle patch over the external auditory canal

08:18 – Otoscopy

08:23 - Postoperative imaging

09:13 - Facial nerve examination

09:23 - Postoperative outcome

Ethical approval:

Institutional Review Board approval is not required.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship:

Nil.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Video available on:

https://doi.org/10.25259/SNI_500_2026

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.