• World Neurosurg · Feb 2019

    Large Intradural Tympanojugular Paragangliomas. A Contribution on Surgery and Management.

    • Antonio Mazzoni, Diego Cazzador, Domenico d'Avella, and Elisabetta Zanoletti.
    • Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Padova, Italy.
    • World Neurosurg. 2019 Feb 1; 122: e1482-e1490.

    ObjectiveLarge intradural growth of tympanojugular paragangliomas (TJ-PGs) into the cerebellopontine angle is an infrequent condition that can determine an extensive involvement of vessels and brainstem, representing a surgical challenge. The current classifications lack accuracy for defining large intradural TJ-PGs and assessing their operability. This study aims to retrospectively reappraise the management of a large intradural TJ-PGs surgical series, discussing operability criteria, treatment strategies, and resection techniques.MethodsOver a series of 63 class D TJ-PGs operated on between 1973 and 2008, patients with large intradural tumors were retrospectively reviewed. Surgical techniques and outcomes with long-term follow-up were analyzed.ResultsSeven patients presented with large intradural tumors, ranging from 4 cm to 5.5 cm in diameter. These cases were treated either via a petro-occipital transsigmoid approach in a single-stage resection (4 patients) or via a petro-occipital approach as a second-stage surgery after a previous infratemporal fossa approach on the extradural tumor (3 patients). Complete tumor resection was obtained in 5 cases through wide removal of the petro-occipital skull base and exposure of the dural root of the tumor, which carries its main blood supply and allows preemptive hemostasis. No new postoperative cranial nerve losses were observed. The surgical procedure was aborted in 2 cases because of cerebellar edema and carotid artery tear, respectively.ConclusionsLarge intradural TJ-PGs can be effectively surgically managed with an appropriate technique combined with relevant nonsurgical strategies. Thus, operability criteria for these lesions can be extended. To share objective experience on large intradural TJ-PGs, a redefinition of Di3 tumors is recalled.Copyright © 2018 Elsevier Inc. All rights reserved.

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