[Problems of hemostasis and excision technic in glomus jugulare tumors]

An artifice is proposed for controlling bleeding during excision of a glomus jugulare tumor. After ligature of the external carotid or ascending pharyngeal arteries, and of the sigmoid sinus, a balloon catheter is introduced into the internal jugular vein. The balloon is then placed at the level of the jugular vein sinus and distended, preventing bleeding from the inferior petrosal sinus and the condylar emissary veins. The operation is conducted in four stages, their order varying according to the extension of the lesion. The mastoid stage involves freeing of the sigmoid sinus and the third portion of the facial nerve. The cervical stage requires freeing of the VIIth nerve at its entry into the parotid, and of the external carotid and internal jugular arteries, and identification of the IXth, Xth, and XIth nerves. During the third cervicomastoid stage, the facial nerve is completely liberated and pushed upwards, and the jugular apophysis of the occipital resected. The last stage is that of preventive hemostasis and excision. The jugular sinus, external carotid artery and internal jugular vein are ligatured. The internal jugular vein is then catheterized with the balloon catheter, which is distended. The jugular vein sinus is opened, the afferent vein orifices clogged, and the lesion excised.