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Lateral skull base surgery for glomus tumors: long-term control
C G Jackson1, B M McGrew, J A Forest
1The Otology Group, Nashville, Tennessee, USA.
Objective:
The age of modern microsurgery has made resection of glomus tumors with extensive skull base involvement possible. Resection of extensive lesions is not without risk of major complication or new cranial nerve deficit. Because glomus tumors are rare and slow growing, data reflecting recurrence risk after resection using modern skull base techniques are lacking. These factors complicate the accurate definition of efficacy of surgical resection and its functional cost. The object of this review is to determine the current incidence of major complications, the surgical cranial nerve deficit, the long-term control rate, and the recurrence risk in patients undergoing surgical resection of glomus jugulare tumors.
Study Design:
Retrospective case review.
Setting:
Private practice tertiary referral center.
Patients And Interventions:
One hundred seventy-six patients with glomus tumors underwent 182 lateral skull base resections between 1972 and 1998.
Main Outcome Measures:
Major complications, tumor recurrence, postoperative functional capacity, and factors affecting the incidence of each were assessed.
Results:
Complete surgical control was achieved in 85% of cases. There were nine cases of recurrence, for a recurrent rate of 5.5% (9/164). Cerebrospinal fluid leakage occurred in 4.5% of cases with intracranial extension. New deficits for cranial nerves IX, X, XI, and XII occurred in 39%, 25%, 26%, and 21% of cases, respectively. Satisfactory functional recovery was achieved in an overwhelming majority of cases. The mortality rate was 2.7% (5/182).
Conclusions:
Surgical resection of glomus tumors is established as an effective technique with good functional outcomes and long-term control.
Insights
Surgical resection of glomus jugulare tumors offers effective long-term control with good functional outcomes. While complications and cranial nerve deficits can occur, recurrence rates are low following modern skull base techniques.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Oncology
Background:
- Glomus jugulare tumors are rare, slow-growing neoplasms.
- Modern microsurgery enables extensive skull base resections.
- Data on recurrence risk after modern resection techniques are limited.
Purpose of the Study:
- To evaluate major complications and cranial nerve deficits after glomus jugulare tumor resection.
- To determine the long-term control rate and recurrence risk.
- To assess the functional outcomes and efficacy of surgical resection.
Main Methods:
- Retrospective case review of 176 patients undergoing 182 lateral skull base resections (1972-1998).
- Assessment of major complications, tumor recurrence, and postoperative functional capacity.
- Analysis of factors influencing complication and recurrence rates.
Main Results:
- Complete surgical control achieved in 85% of cases; recurrence rate was 5.5%.
- Cerebrospinal fluid leakage occurred in 4.5% of cases with intracranial extension.
- New deficits for cranial nerves IX-XII ranged from 21% to 39%; mortality rate was 2.7%.
Conclusions:
- Surgical resection is an effective treatment for glomus jugulare tumors.
- The procedure offers good functional outcomes and long-term tumor control.
- Modern skull base techniques balance efficacy with acceptable complication rates.
