Abstract
Objectives: To review surgical outcomes in patients with complex jugular
paragangliomas(CJPs)and to refine the surgical strategies for CJPs.
Design: A retrospective study . Setting: A single university hospital.
Participants: Twelve patients with CJPs diagnosed in our institution
from January 2013 to January 2021. Main Outcome Measures: Individualized
surgical strategies, tumor control, complications, function of facial
nerve (FN) and lower cranial nerves (LCNs), postoperatively. Results:
Gross-total resection was achieved for 9 (75%) patients, and subtotal
resection was achieved for 3(25%) patients. The surgical tumor control
rate was 100% after a mean follow-up of 37.5 months. New FN dysfunction
occurred in 33.3% (4/12) of patients, including 3 patients restored to
HB grade II postoperatively, and new LCNs deficits occurred in 16.7%
(2/12) patients. One patient suffered from mild hemiparesis as a result
of postoperative lacunar cerebral infarction resolved two months later.
No other obvious complications noted in our series. Conclusion: Our
unique refined surgical techniques, including tension-free anterior FN
rerouting, sigmoid sinus tunnel-packing and push-packing techniques,
were able to achieve maximum tumor control and cranial nerves
preservation. A two-stage surgery should be applied to minimize the risk
of bilateral cranial neuropathies and impact on cerebral circulation in
patients with bilateral paragangliomas. The preoperative endovascular
intervention such as coil embolization or internal carotid artery (ICA)
stenting can be employed in management paragangliomas with ICA
associated lesions.