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Postoperative infection of the skull base surgical site due to suppurative parotitis: A case report
Yong Zhao1, Yang Zhao1, Li-Qin Zhang1
1Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Background:
Paraganglioma occurring at the lateral skull base is a rare tumor. Surgery is the primary treatment of benign paragangliomas. Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage.
Case Summary:
A 30-year-old man with a 1-year history of left-side progressive hearing loss, tinnitus, facial palsy, and choking failed conventional treatment and is the focus of this case report. Imaging revealed a mass around the left jugular foramen that was approximately 47 mm × 38 mm × 34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery. The tumor breached the meninges and occupied the cerebella pontine region. A two-stage surgery was designed for the resection of the mass. In the first-stage, the epidural portion of the mass was removed. The abdominal fat and the temporal muscle flap were transposed within the surgical site. The surgery was successful; however, 25 d after surgery, he developed suppurative parotitis, and the infection spread to the surgical site at the skull base. Broad-spectrum antibiotics were used, and debridement was deployed. After that, the wound was cleaned daily. Five months after the first-stage surgery, the wound was still unclosed, and there was intermittent purulent exudation within the surgical site. vacuum sealing drainage (VSD) was used, and the wound healed in a month. One year after the first surgery, the second-stage of the operation was performed to remove the intracranial portion of the tumor. Recurrence of the tumor was not detected after a 6-month follow-up.
Conclusion:
After a lateral skull base surgery, suppurative parotitis can spread into the operative cavity leading to infection of the surgical site. VSD can help to effectively heal the infected wound. A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.
Insights
Lateral skull base paragangliomas require complex surgical management. A two-stage approach and vacuum sealing drainage (VSD) effectively treated a large tumor and subsequent infection.
Area of Science:
- Neurosurgery
- Oncology
- Otolaryngology
Background:
- Paragangliomas at the lateral skull base are rare, with surgery being the primary treatment for benign forms.
- Postoperative infections at the lateral skull base surgical site pose significant risks and management challenges.
Observation:
- A case report details a 30-year-old male with a large lateral skull base paraganglioma causing hearing loss, tinnitus, and facial palsy.
- The tumor eroded bone, breached the meninges, and occupied the cerebellopontine region, necessitating a two-stage surgical resection.
- Postoperatively, the patient developed suppurative parotitis that spread to the surgical site, leading to a persistent, infected wound.
Findings:
- A two-stage surgical approach was employed for tumor resection.
- Vacuum sealing drainage (VSD) was instrumental in achieving wound closure and healing of the infected surgical site.
- The patient showed no recurrence of the paraganglioma after a 6-month follow-up post-second-stage surgery.
Implications:
- Suppurative parotitis following lateral skull base surgery can lead to dangerous surgical site infections.
- Vacuum sealing drainage (VSD) offers an effective method for managing complex infected wounds in this region.
- A staged surgical strategy may provide a safer alternative for resecting extensive lateral skull base paragangliomas involving the meninges.
