Clinical Presentation and Management of Jugular Foramen Paraganglioma

OBJECTIVES: Jugular foramen paraganglioma is a locally invasive, benign tumor, which grow slowly and causes various symptoms such as pulsatile tinnitus and low cranial nerve palsy. Complete surgical resection is regarded as the ideal management of these tumors. The goal of this study is to identify the clinical characteristics and most effective surgical approach for jugular foramen paraganglioma. METHODS: Retrospective analysis of 9 jugular foramen paraganglioma patients who underwent surgical resection between 1986 and 2005 was performed. Clinical records were reviewed for analysis of initial clinical symptoms and signs, audiological examinations, neurological deficits, radiological features, surgical approaches, extent of resection, treatment outcomes and complications. RESULTS: Most common initial symptom was hoarseness, followed by pulsatile tinnitus. Seven out of 9 patients had at least one low cranial nerve palsy. Seven patients were classified as Fisch Type C tumor and remaining 2 as Fisch Type D tumor on radiologic examination. Total of 11 operations took place in 9 patients. Total resection was achieved in 6 cases, when partial resection was done in 3 cases. Two patients with partial resection received gamma knife radiosurgery (GKS), when remaining 1 case received both GKS and two times of revision operation. No mortality was encountered and there were few postoperative complications. CONCLUSION: Neurologic examination of low cranial nerve palsy is crucial since most patients had at least one low cranial nerve palsy. All tumors were detected in advanced stage due to slow growing nature and lack of symptom. Angiography with embolization is crucial for successful tumor removal without massive bleeding. Infratemporal fossa approach can be considered as a safe, satisfactory approach for removal of jugular foramen paragangliomas. In tumors with intracranial extension, combined approach is recommended in that it provides better surgical view and can maintain the compliance of the patients.

Parapharyngeal Second Branchial Cleft Cyst Extending to the Skull Base: A Lateral Transcranial Infratemporal fossa Approach

Branchial cleft cysts, sinuses, and fistulae are classified as first, second, third and fourth branchial cleft anomalies. They represent the congenital anomalies resulting from defects in the normal maturation of the branchial apparatus. Second branchial cleft anomalies occur more commonly than other branchial cleft anomalies. Most branchial cysts from the second branchial cleft are found deep in the sternocleidomastoid muscle or along its anterior border. Recognizing and diagnosing lateral neck cysts correctly are not difficult for an expert physician, although an unusual localization may cause problems in differential diagnosis. Complete excision of branchial cleft cysts is necessary to avoid recurrence. Approaches to the lesions are depending on the location and extent of the lesion. This article presents an unusual case of parapharyngeal branchial cleft cyst extending the skull base. Excision of the lesion was achieved via the lateral transcranial infratemporal fossa approach with zygomato-temporal craniotomy. This approach provides access not only to all of the subcranial tissues that underlie the middle cranial fossa, but to the maxillary or sphenoid sinus.

Osteochonrdoma Of The Mandibular Condyle: A Case Report

The osteochondroma, also known as osteocartilaginous exostosis, is one of the most common benign tumors of the axial skeleton. These tumours rarely affect the facial skeleton and a true osteochondroma of the mandibular condyle is a very uncommon entity. The tumors are usually slow growing, and symptoms develop over a long time. The most common presentation of the condylar osteochondroma consists of a changing occlusion, the development of facial asymmetry, and a posterior open bite on the affected side. In this case, we treated an osteochondroma of Lt. mandibular condyle through excision of the lesion via the temporal approach to the temporomandibular joint.

Surgical Resection of Glomus Jugulare Tumor via Infratemporal Approach after Preoperative Embolization

Glomus jugulare tumors are usually slow growing, but highly vascularized tumor. The authors report the case of huge glomus jugulare tumor treated by surgical resection with preoperative embolization. A 32-year old male patient presented with a history of right-sided facial palsy and hearing disturbance. Magnetic resonance imaging demonstrated an irregular large mass with multiple signal voids in the right temporal area. Prior to surgical excision of tumor, the patient underwent superselective embolization. Embolization of the tumor and its dominant feeding arteries were achieved. Six days later, the patient underwent an infratemporal fossa approach to remove the tumor. The patient did well postoperatively except CSF leakage that was treated successfully by dura repair. We discuss the usefulness of preoperative embolization and infratemporal approach for the huge glomus jugulare tumor.

Trigeminal Neurinomas: Report of 8 Cases with Special Reference to Operative Approach

The authors have treated eight cases of trigeminal neurinomas for the past thirteen years. We have been treating these tumors in accordance with the principle of radical resection through one-staged operation. Three were male and five were female. The age ranged from 25 to 56 years with the mean age of 41.5 years. One was a case of von Recklinghausen's disease. Topographically, the tumors were mainly located within the middle fossa in two cases, within the posterior fossa in two, and extended both supra- and infratentorially in four cases. Facial pain and hearing disturbance were the main symptoms and various other symptoms such as focal seizure, hemiparesis, gait disturbance, symptoms of increased intracranial pressure and visual disturbance were also noted. Surgical operations were performed in all cases. As a surgical approach, either transpetrosal-transtentorial or orbitozygomatic-infratemporal route was employed. The choice of the better approach depends on the topography of the tumor. Total removal was performed in all cases. Only one case, which was an early one in this series required second operation to remove the tumor completely. In one case, the tumor recurred five years after the operation. There has been no operative mortality, but the injury or permanent damage to the trigeminal branches was inevitable in many cases. Surgical results were excellent in three, good in four, and fair in one case.

Thrombosed Giant Posterior Communicating Aneurysm Simulating Brain Neoplasm: A Case Report

A giant intracranial aneurysm(GIA) is an aneurysm greater than 2.5cm in size. GIA may simulate brain tumor on computed tomography scans. We report a case of giant thrombosed posterior communicating artery aneurysm simulating brain tumor. To minimize brain retraction and achieve excellent exposure in the shortest possible distance during the operation, we used a new surgical technique, an orbitozygomatic infratemporal approach, with good results.