Skip to main content
PMC home page
Skull Base Surgery logoLink to Skull Base Surgery
. 1999;9(3):185–194. doi: 10.1055/s-2008-1058145

An Update on the Surgical Treatment of Temporal Bone Paraganglioma

Kris S Moe, Daqing Li, Thomas E Linder, Stephan Schmid, Ugo Fisch
PMCID: PMC1656735  PMID: 17171088

Abstract

In 1982, Fisch described his results for the surgical treatment of 74 paragangliomas of the temporal bone, 5 years after his description of the infratemporal fossa approaches (types A and B). This study reviews the subsequent experience of the Department of Otolaryngology—Head and Neck Surgery of the University of Zürich with more than 136 surgically treated cases of paraganglioma of the temporal bone and discusses our current therapy 20 years after the initial description. One hundred nineteen (90%) of the patients had advanced tumors (Fisch class C or C+D), and 81 (68%) had intracranial extension. Total tumor excision was possible in 109 (82%) patients. Subtotal excision was performed in 22 (17%) patients, 21 of whom had intradural tumor invasion. In these cases, the resection was limited not by actual tumor size but by the degree of intracranial intradural tumor extension. Partial tumor excision was undertaken in only 1 patient with a C4De2Di2 tumor. The success rate in preservation of function of the lower cranial nerves was encouraging. Of the 69 patients whose facial nerve status was followed post-operatively, 81% maintained Fisch grade 76 to 100% (House-Brackman grades I and II). Analysis of follow-up data ranging from 2 to 11 years demonstrated 98% disease-free survival when total tumor extirpation was possible. In the patients who underwent subtotal or partial surgical resection there has been no subsequent tumor growth detected by either clinical or neuroradiological evaluation. We have confirmed after more than 20 years of experience that the infratemporal fossa approaches are a safe, highly effective means of surgical management of paragangliomas of the temporal bone, allowing eradication or arrest of disease with minimal morbidity. Limited intradural surgical resection in cases of very extensive tumors can greatly benefit patients for whom complete excision is not an option.

Full text

PDF
186

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boyle J. O., Shimm D. S., Coulthard S. W. Radiation therapy for paragangliomas of the temporal bone. Laryngoscope. 1990 Aug;100(8):896–901. doi: 10.1288/00005537-199008000-00018. [DOI] [PubMed] [Google Scholar]
  2. Brackmann D. E., House W. F., Terry R., Scanlan R. L. Glomus jugulare tumors: effect of irradiation. Trans Am Acad Ophthalmol Otolaryngol. 1972 Nov-Dec;76(6):1423–1431. [PubMed] [Google Scholar]
  3. Carrasco V., Rosenman J. Radiation therapy of glomus jugulare tumors. Laryngoscope. 1993 Nov;103(11 Pt 2 Suppl 60):23–27. doi: 10.1002/lary.1993.103.s60.23. [DOI] [PubMed] [Google Scholar]
  4. Cole J. M. Glomus jugulare tumor. Laryngoscope. 1977 Aug;87(8):1244–1258. doi: 10.1288/00005537-197708000-00003. [DOI] [PubMed] [Google Scholar]
  5. Dickens W. J., Million R. R., Cassisi N. J., Singleton G. T. Chemodectomas arising in temporal bone structures. Laryngoscope. 1982 Feb;92(2):188–191. doi: 10.1002/lary.1982.92.2.188. [DOI] [PubMed] [Google Scholar]
  6. Fisch U. Infratemporal fossa approach to tumours of the temporal bone and base of the skull. J Laryngol Otol. 1978 Nov;92(11):949–967. doi: 10.1017/s0022215100086382. [DOI] [PubMed] [Google Scholar]
  7. Fisch U. Surgery for Bell's palsy. Arch Otolaryngol. 1981 Jan;107(1):1–11. doi: 10.1001/archotol.1981.00790370003001. [DOI] [PubMed] [Google Scholar]
  8. Gardner G., Cocke E. W., Jr, Robertson J. T., Trumbull M. L., Palmer R. E. Combined approach surgery for removal of glomus jugulare tumors. Laryngoscope. 1977 May;87(5 Pt 1):665–688. doi: 10.1002/lary.5540870503. [DOI] [PubMed] [Google Scholar]
  9. Gibbin K. P., Henk J. M. Glomus jugulare tumours in South Wales--a twenty-year review. Clin Radiol. 1978 Nov;29(6):607–609. doi: 10.1016/s0009-9260(78)80178-0. [DOI] [PubMed] [Google Scholar]
  10. Green J. D., Jr, Brackmann D. E., Nguyen C. D., Arriaga M. A., Telischi F. F., De la Cruz A. Surgical management of previously untreated glomus jugulare tumors. Laryngoscope. 1994 Aug;104(8 Pt 1):917–921. doi: 10.1288/00005537-199408000-00001. [DOI] [PubMed] [Google Scholar]
  11. Guida R. A., Finn D. G., Buchalter I. H., Brookler K. H., Kimmelman C. P. Radiation injury to the temporal bone. Am J Otol. 1990 Jan;11(1):6–11. [PubMed] [Google Scholar]
  12. Handel S. F., Miller M. H., Miller L. S., Goepfert H., Wallace S. Angiographic changes of head and neck chemodectomas following radiotherapy. Arch Otolaryngol. 1977 Feb;103(2):87–89. doi: 10.1001/archotol.1977.00780190067006. [DOI] [PubMed] [Google Scholar]
  13. Hawthorne M. R., Makek M. S., Harris J. P., Fisch U. The histopathological and clinical features of irradiated and nonirradiated temporal paragangliomas. Laryngoscope. 1988 Mar;98(3):325–331. doi: 10.1288/00005537-198803000-00018. [DOI] [PubMed] [Google Scholar]
  14. Heutink P., van der Mey A. G., Sandkuijl L. A., van Gils A. P., Bardoel A., Breedveld G. J., van Vliet M., van Ommen G. J., Cornelisse C. J., Oostra B. A. A gene subject to genomic imprinting and responsible for hereditary paragangliomas maps to chromosome 11q23-qter. Hum Mol Genet. 1992 Apr;1(1):7–10. doi: 10.1093/hmg/1.1.7. [DOI] [PubMed] [Google Scholar]
  15. Konefal J. B., Pilepich M. V., Spector G. J., Perez C. A. Radiation therapy in the treatment of chemodectomas. Laryngoscope. 1987 Nov;97(11):1331–1335. doi: 10.1288/00005537-198711000-00016. [DOI] [PubMed] [Google Scholar]
  16. Lalwani A. K., Jackler R. K., Gutin P. H. Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor. Am J Otol. 1993 Jul;14(4):398–402. [PubMed] [Google Scholar]
  17. Makek M., Franklin D. J., Zhao J. C., Fisch U. Neural infiltration of glomus temporale tumors. Am J Otol. 1990 Jan;11(1):1–5. [PubMed] [Google Scholar]
  18. McCaffrey T. V., Meyer F. B., Michels V. V., Piepgras D. G., Marion M. S. Familial paragangliomas of the head and neck. Arch Otolaryngol Head Neck Surg. 1994 Nov;120(11):1211–1216. doi: 10.1001/archotol.1994.01880350023005. [DOI] [PubMed] [Google Scholar]
  19. Schwaber M. K., Gussack G. S., Kirkpatrick W. The role of radiation therapy in the management of catecholamine-secreting glomus tumors. Otolaryngol Head Neck Surg. 1988 Feb;98(2):150–154. doi: 10.1177/019459988809800209. [DOI] [PubMed] [Google Scholar]
  20. Sharma P. D., Johnson A. P., Whitton A. C. Radiotherapy for jugulo-tympanic paragangliomas (glomus jugulare tumours). J Laryngol Otol. 1984 Jun;98(6):621–629. doi: 10.1017/s0022215100147188. [DOI] [PubMed] [Google Scholar]
  21. Simko T. G., Griffin T. W., Gerdes A. J., Parker R. G., Tesh D. W., Taylor W., Blasko J. C. The role of radiation therapy in the treatment of glomus jugulare tumors. Cancer. 1978 Jul;42(1):104–106. doi: 10.1002/1097-0142(197807)42:1<104::aid-cncr2820420117>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  22. Sobol S. M., Dailey J. C. Familial multiple cervical paragangliomas: report of a kindred and review of the literature. Otolaryngol Head Neck Surg. 1990 Apr;102(4):382–390. doi: 10.1177/019459989010200413. [DOI] [PubMed] [Google Scholar]
  23. Spector G. J., Ciralsky R. H., Ogura J. H. Glomus tumors in the head and neck: III. Analysis of clinical manifestations. Ann Otol Rhinol Laryngol. 1975 Jan-Feb;84(1 Pt 1):73–79. doi: 10.1177/000348947508400111. [DOI] [PubMed] [Google Scholar]
  24. Spector G. J., Compagno J., Perez C. A., Maisel R. H., Ogura J. H. Glomus jugulare tumors: effects of radiotherapy. Cancer. 1975 May;35(5):1316–1321. doi: 10.1002/1097-0142(197505)35:5<1316::aid-cncr2820350511>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  25. Spector G. J., Fierstein J., Ogura J. H. A comparison of therapeutic modalities of glomus tumors in the temporal bone. Laryngoscope. 1976 May;86(5):690–696. doi: 10.1288/00005537-197605000-00009. [DOI] [PubMed] [Google Scholar]
  26. Spector G. J., Maisel R. H., Ogura J. H. Glomus jugulare tumors. II. A clinicopathologic analysis of the effects of radiotherapy. Ann Otol Rhinol Laryngol. 1974 Jan-Feb;83(1):26–32. doi: 10.1177/000348947408300106. [DOI] [PubMed] [Google Scholar]
  27. Tidwell T. J., Montague E. D. Chemodectomas involving the temporal bone. Radiology. 1975 Jul;116(1):147–149. doi: 10.1148/116.1.147. [DOI] [PubMed] [Google Scholar]
  28. Wang M. L., Hussey D. H., Doornbos J. F., Vigliotti A. P., Wen B. C. Chemodectoma of the temporal bone: a comparison of surgical and radiotherapeutic results. Int J Radiat Oncol Biol Phys. 1988 Apr;14(4):643–648. doi: 10.1016/0360-3016(88)90084-3. [DOI] [PubMed] [Google Scholar]
  29. Woods C. I., Strasnick B., Jackson C. G. Surgery for glomus tumors: the Otology Group experience. Laryngoscope. 1993 Nov;103(11 Pt 2 Suppl 60):65–70. doi: 10.1002/lary.1993.103.s60.65. [DOI] [PubMed] [Google Scholar]
  30. de Jong A. L., Coker N. J., Jenkins H. A., Goepfert H., Alford B. R. Radiation therapy in the management of paragangliomas of the temporal bone. Am J Otol. 1995 May;16(3):283–289. [PubMed] [Google Scholar]
  31. van Baars F., van den Broek P., Cremers C., Veldman J. Familial non-chromaffinic paragangliomas (glomus tumors) : clinical aspects. Laryngoscope. 1981 Jun;91(6):988–996. [PubMed] [Google Scholar]
  32. van der Mey A. G., Frijns J. H., Cornelisse C. J., Brons E. N., van Dulken H., Terpstra H. L., Schmidt P. H. Does intervention improve the natural course of glomus tumors? A series of 108 patients seen in a 32-year period. Ann Otol Rhinol Laryngol. 1992 Aug;101(8):635–642. doi: 10.1177/000348949210100802. [DOI] [PubMed] [Google Scholar]

Articles from Skull base surgery are provided here courtesy of Thieme Medical Publishers

RESOURCES