The Clinical Effects of Modified Infratemporal Fossa Approach Type A for Glomus Jugulare Tumors in 39 Patients

Abstract

Objective To analyze the clinical effects of modified infratemporal fossa type A approach for glomus jugulare tumors. Methods The clinical data of patients with glomus jugulare tumors who received modified infratemporal fossa approach type A from May 2014 to December 2019 were retrospectively collected in the Beijing Tiantan Hospital, Capital Medical University. Modified infratemporal fossa approach type A was performed and improved on two aspects: anterior transfer of facial nerve and management of sigmoid sinus. CT was performed 6 hours after surgery to exclude intracranial hemorrhage. MRI was reviewed 2 weeks after surgery to define residual tumor, and every year to determine recurrence. Follow-up was conducted to assess the facial nerve function. Results A total of 39 patients were included in this study. Patients' grades of preoperative facial nerve function according to House-Brackmann (HB) were as following: grade Ⅰ in 12 patients, grade Ⅱ in 6 cases, grade Ⅲ in 8 cases, grade Ⅳ in 9 cases, grade Ⅴ in 3 cases, and grade Ⅵ in 1 case. All 39 patients successfully completed surgery, and there were no deaths and no severe complications such as hemiplegia, or intracranial infections. Cerebrospinal fluid leakage occurred in 1 case and drainage was performed. There was no intracranial hemorrhage in the CT exam 6 hours after surgery. Total resection was performed in 37 cases (94.9%) and nearly total resection in 2 cases (5.1%). The postoperative facial function after 1 year was HB grade Ⅰ in 8 patients, grade Ⅱ in 16 cases, grade Ⅲ in 9 cases, grade Ⅳ in 4 cases, grade Ⅴ in 2 cases. The facial function was improved after the surgery(P < 0.05). One year after surgery, tumor recurrence occurred in 1 patient and radiotherapy was performed. There was no significant tumor enlargement during follow-up. Conclusions The modified infratemporal fossa approach type A keeps the advantage of classical approach. By adjusting the anterior transfer of the facial nerve, the preservation of facial nerve function was improved. By compressing the sigmoid sinus instead of ligation, the occurrence of brain injury and cerebrospinal fluid leakage were reduced.

Keywords

• infratemporal fossa type a approach
• modified
• glomus jugulare tumor
• facial function
• cerebrospinal fluid leakage