Lateral skull base surgery for glomus tumors: long-term control.

OBJECTIVE: The age of modern microsurgery has made resection of glomus tumors with extensive skull base involvement possible. Resection of extensive lesions is not without risk of major complication or new cranial nerve deficit. Because glomus tumors are rare and slow growing, data reflecting recurrence risk after resection using modern skull base techniques are lacking. These factors complicate the accurate definition of efficacy of surgical resection and its functional cost. The object of this review is to determine the current incidence of major complications, the surgical cranial nerve deficit, the long-term control rate, and the recurrence risk in patients undergoing surgical resection of glomus jugulare tumors. STUDY DESIGN: Retrospective case review. SETTING: Private practice tertiary referral center. PATIENTS AND INTERVENTIONS: One hundred seventy-six patients with glomus tumors underwent 182 lateral skull base resections between 1972 and 1998. MAIN OUTCOME MEASURES: Major complications, tumor recurrence, postoperative functional capacity, and factors affecting the incidence of each were assessed. RESULTS: Complete surgical control was achieved in 85% of cases. There were nine cases of recurrence, for a recurrent rate of 5.5% (9/164). Cerebrospinal fluid leakage occurred in 4.5% of cases with intracranial extension. New deficits for cranial nerves IX, X, XI, and XII occurred in 39%, 25%, 26%, and 21% of cases, respectively. Satisfactory functional recovery was achieved in an overwhelming majority of cases. The mortality rate was 2.7% (5/182). CONCLUSIONS: Surgical resection of glomus tumors is established as an effective technique with good functional outcomes and long-term control.

Long-term control of surgically treated glomus tympanicum tumors.

OBJECTIVE: The glomus tumor is an enigmatic middle ear neoplasm commonly delayed in diagnosis. Frequently grouped with its skull base counterpart, surgery and radiation are often recommended as therapy. The objective of this report is to highlight the diagnosis and surgical treatment of this neoplasm in a large series. Tumor control in the long term is defined. STUDY DESIGN: Retrospective case review. SETTING: Private practice-tertiary referral center. PATIENTS: All patients surgically treated for glomus tympanicum tumors from May 25, 1972 to July 3, 1998 (N = 80). INTERVENTIONS: Surgical excision of glomus tympanicum tumors. MAIN OUTCOME MEASURE: Total tumor control in the long term. RESULTS: Surgical treatment resulted in long-term tumor control for the vast majority of the patients studied. CONCLUSIONS: Surgery provides excellent control of glomus tympanicum tumors. It is safe and well tolerated, with minimal morbidity.

Comparison of postoperative headache after retrosigmoid approach: vestibular nerve section versus vestibular schwannoma resection.

OBJECTIVE: To evaluate intradural drilling as a mechanism for the development of postoperative headache after retrosigmoid craniectomy. STUDY DESIGN: A retrospective review of charts was performed on 565 retrosigmoid approaches to the cerebellopontine angle performed between January 1980 and January 1998. Patients treated with retrosigmoid vestibular nerve section without intradural drilling were compared with patients who underwent retrosigmoid removal of vestibular schwannomas in which intradural drilling was performed for exposure of the internal auditory canal. SETTING: Private practice tertiary referral center. PATIENTS: Consecutive patients undergoing retrosigmoid approach between January 1980 and January 1998 were reviewed. MAIN OUTCOME MEASURES: The presence of headache, duration of headache, and severity of headache were noted. RESULTS: In this large series, 54% of patients experienced headaches after vestibular schwannoma removal, and 5% of patients experienced headaches after vestibular nerve section (p < 0.01, chi-square). CONCLUSIONS: Postoperative headache is not a characteristic of retrosigmoid craniectomy in the absence of intradural drilling. Intradural drilling is a probable cause of headache after the retrosigmoid approach. Cranioplasty is not necessary to prevent a high incidence of postoperative headache after retrosigmoid approach.