Department of Neurosurgery, Lariboisiere Hospital Paris, Paris, France.
Neurosurg Rev. 2012 Apr;35(2):185-94; discussion 194. doi: 10.1007/s10143-011-0346-1. Epub 2011 Sep 23.
Jugular foramen paragangliomas are rare skull base tumours posing multiple complex diagnostic and management problems. We did a study to evaluate surgical technique, outcome and complications in 75 cases of tumours treated by multidisciplinary approach (i.e. combined neurosurgery, neuroradiology, ear, nose and throat surgery and intensive care unit team). Retrospective study on 75 consecutive patients with jugular foramen paragangliomas treated surgically from 1989 to 2005. Preoperative balloon occlusion test was performed in all patients as well as embolization (100%). A combined limited infratemporal and juxtacondylar approach was used in all patients. Gross total resection was achieved in 59 patients (78.7%). The most common complication was represented by lower cranial nerve deficits in five patients (6.6%), which was only temporary in three. Postoperative facial nerve weakness occurred in five cases (6.6%) and resolved in three of them. The remaining two patients underwent facial nerve reconstruction by hypoglossal/facial nerve anastomosis. Four patients (5.3%) had a postoperative cerebrospinal fluid leak, which was successfully treated by lumbar drainage. Two patients (2.7%) died because of complications related to surgical injury of lower cranial nerves: one patient developed aspiration pneumonia and septicemia and the second one developed a large cervico-bulbar hematoma that led to severe respiratory distress and ultimately global cerebral hypoxia. Paragangliomas are rare and complex skull base lesions that may be managed with low morbidity and mortality if a multidisciplinary approach is considered. Facial and lower cranial nerve postoperative deficits can be limited.
颈静脉孔副神经节瘤是一种罕见的颅底肿瘤，具有多种复杂的诊断和治疗问题。我们进行了一项研究，评估了多学科方法（即神经外科、神经放射学、耳鼻喉科手术和重症监护团队联合治疗）治疗的 75 例肿瘤的手术技术、结果和并发症。回顾性研究了 1989 年至 2005 年间接受手术治疗的 75 例连续颈静脉孔副神经节瘤患者。所有患者均进行了术前球囊阻塞试验和栓塞（100%）。所有患者均采用联合局限性颞下和髁突下入路。59 例患者（78.7%）达到大体全切除。最常见的并发症是 5 例患者（6.6%）出现颅神经损伤，其中 3 例为暂时性的。术后面神经无力发生在 5 例（6.6%）患者中，其中 3 例恢复。另外 2 例患者通过舌下神经/面神经吻合术进行面神经重建。4 例（5.3%）患者发生术后脑脊液漏，通过腰椎引流成功治疗。2 例（2.7%）患者因手术损伤颅神经相关并发症死亡：1 例发生吸入性肺炎和败血症，另 1 例发生颈髓-脑桥大血肿，导致严重呼吸窘迫，最终导致全脑缺氧。副神经节瘤是罕见的复杂颅底病变，如果考虑多学科方法治疗，可以降低发病率和死亡率。术后面神经和颅神经损伤可以得到限制。
