Resection of a recurrent paraganglioma via an endoscopic transnasal approach to the jugular fossa.

OBJECTIVE

To present a novel endoscopic, transnasal approach to a recurrent paraganglioma of the jugular fossa (glomus jugulare).

STUDY DESIGN

Case report and review of the literature.

SETTING

The study was carried out at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

PATIENT

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.

INTERVENTION

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.

RESULTS

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.

CONCLUSION

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.