Zimmer Lee A, Hirsch Barry E, Kassam Amin, Horowitz Michael, Snyderman Carl H
Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2546, USA.
Otol Neurotol. 2006 Apr;27(3):398-402. doi: 10.1097/00129492-200604000-00017.
To present a novel endoscopic, transnasal approach to a recurrent paraganglioma of the jugular fossa (glomus jugulare).
Case report and review of the literature.
The study was carried out at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
A 64-year-old woman presented to the University of Pittsburgh Medical Center with a 9-month history of left otalgia, occasional vertigo, facial pain, and recurrent epistaxis. She had undergone two previous procedures over the past 35 years for a glomus tympanicum. Physical examination revealed a mass in the left nasopharynx originating from the eustachian tube. A computed tomographic scan revealed an expansive mass in the left jugular foramen extending into the posterior parapharyngeal space suggestive of a large jugular paraganglioma.
The patient underwent preoperative embolization of the paraganglioma. An endoscopic, transnasal approach along the eustachian tube, the ascending parapharyngeal carotid artery, and into the jugular fossa was used to remove the tumor. Intraoperative image guidance assisted in the identification of key anatomic landmarks.
Postoperative magnetic resonance imaging revealed a thin rim of enhancement at the posterior aspect of the jugular fossa consistent with residual tumor. The patient was discharged to home on postoperative Day 1 in stable condition. There have been no complications with 4 months of follow-up, and the left facial paralysis secondary to preoperative embolization has resolved.
We report the successful subtotal resection of a recurrent paraganglioma via a novel endoscopic, transnasal, transclival, transpetrous approach with image guidance. This approach allowed the near-total resection of a recurrent glomus jugulare with minimal surgical morbidity. Technological advances and surgical experience with nasal endoscopy and image guidance allow minimally invasive surgical management of select extracranial lesions of the lateral cranial base.
介绍一种用于治疗颈静脉孔（颈静脉球瘤）复发性副神经节瘤的新型内镜经鼻入路。
病例报告及文献复习。
美国宾夕法尼亚州匹兹堡市匹兹堡大学医学中心。
一名64岁女性因左侧耳痛9个月、偶发眩晕、面部疼痛及反复鼻出血就诊于匹兹堡大学医学中心。在过去35年里，她曾因鼓室球瘤接受过两次手术。体格检查发现左侧鼻咽部有一肿物，起源于咽鼓管。计算机断层扫描显示左侧颈静脉孔有一膨胀性肿物，延伸至咽旁后间隙，提示为巨大颈静脉副神经节瘤。
患者接受了副神经节瘤的术前栓塞。采用沿咽鼓管、咽旁颈动脉升支并进入颈静脉孔的内镜经鼻入路切除肿瘤。术中影像引导有助于识别关键解剖标志。
术后磁共振成像显示颈静脉孔后方有一薄层强化影，符合残留肿瘤表现。患者术后第1天病情稳定出院。随访4个月无并发症发生，术前栓塞所致的左侧面神经麻痹已恢复。
我们报告了通过一种新型内镜经鼻、经斜坡、经岩骨入路并结合影像引导成功次全切除复发性副神经节瘤。该入路使复发性颈静脉球瘤得以近乎全切除，手术并发症最少。鼻内镜和影像引导技术的进步及手术经验使得对部分颅外侧颅底病变可进行微创外科治疗。
