Infratemporal approach to skull base for glomus tumors: anatomic considerations

Modifications in the current techniques of infratemporal fossa surgery for large glomus tumors arising from the jugular bulb can reduce the postoperative cranial nerve deficits and preserve serviceable hearing without compromising tumor removal. Glomus tumors arising from the jugular bulb tend to involve the temporal bone and vasculature of the skull base medial to the vertical facial nerve. By approaching these tumors from below, it is possible to preserve the cochlea, eustachian tube, and middle ear structures, and still obtain complete tumor removal. The surgical technique and experience in using this approach for the removal of glomus tumors from the temporal bone, petrous apex, carotid artery, jugular bulb, and infratemporal fossa are reviewed.