[One stage removal of huge glomus tumor]

Surgical removal of a huge glomus jugular tumor has been considered as one of the most difficult skull base surgeries not only because of the difficulty in approaching the tumor, but also because of its highly vascular nature and various possible postoperative complications. We used combined infratemporal fossa and lateral suboccipital approach in a single stage to operate on a 49-year-old male with a huge glomus jugular tumor, which extended from the right cerebellopontine angle to the level of the the third vertebra. With this approach we could expose the tumor extensively and control the feeding arteries easily in spite of marked vascularity of the tumor. Retraction of the cerebellum was only minimal owing to the removal of the petrous bone. The tumor was excised not by piecemeal but in en block manner with preservation of all the cranial nerves but the glossopharyngeal nerve. To prevent postoperative cerebrospinal fluid leakage, the following procedures were very useful; 'blind sack closure' of the external auditory canal, careful closure of the Eustachian tube, use of the pedicled muscle flap from the temporal and the sternocleidomastoid muscle, use of fibrin glue at the time of the wound closure, and placement of preventive spinal drainage. The patient was discharged with hoarseness and facial palsy. However these symptoms had almost completely disappeared within one year. He is working in the same occupation as before.