Liu James K, Zhao Kevin, Baredes Soly, Jyung Robert W
Department of Neurological Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Livingston and Newark, New Jersey, United States.
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark, New Jersey, United States.
J Neurol Surg B Skull Base. 2021 Feb;82(Suppl 1):S59-S60. doi: 10.1055/s-0040-1716532. Epub 2020 Nov 26.
Glomus vagale tumor is a paraganglioma of the vagus nerve. It is a rare type of benign tumor that occupies the head and neck and skull base regions. Patients often present with lower cranial nerve dysfunctions such as difficulty swallowing, tongue weakness, and hoarseness. Surgical treatment can be complex and difficult due to its high vascularity, frequent involvement of lower cranial nerves, and surrounding critical vascular structures. In this operative video, we demonstrate an extended anterolateral infralabyrinthine transjugular approach for microsurgical resection of a giant glomus vagale tumor in a 53-year-old male who presented with an enlarging neck mass, difficulty swallowing, right tongue weakness, and hoarseness. Imaging revealed a giant glomus vagale tumor in the right parapharyngeal space extending into the jugular foramen with occlusion of the internal jugular vein. After preoperative embolization, the patient underwent a near-total resection of the tumor with a small microscopic residual at the pars nervosa. In summary, the extended anterolateral infralabyrinthine transjugular approach is a useful strategy for removal of giant glomus vagale tumors extending into the skull base. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video. The link to the video can be found at: https://youtu.be/L0EosQK95LE .
迷走神经球瘤是一种迷走神经的副神经节瘤。它是一种罕见的良性肿瘤，位于头颈部和颅底区域。患者常表现为下颅神经功能障碍，如吞咽困难、舌肌无力和声音嘶哑。由于其血管丰富、常累及下颅神经以及周围关键血管结构，手术治疗可能复杂且困难。在本手术视频中，我们展示了一种扩大的前外侧迷路下经颈静脉入路，用于对一名53岁男性的巨大迷走神经球瘤进行显微手术切除，该患者表现为颈部肿块增大、吞咽困难、右侧舌肌无力和声音嘶哑。影像学检查显示右侧咽旁间隙有一个巨大的迷走神经球瘤，延伸至颈静脉孔，颈内静脉闭塞。术前栓塞后，患者接受了肿瘤近全切除，神经部有一小片显微镜下残留。总之，扩大的前外侧迷路下经颈静脉入路是切除延伸至颅底的巨大迷走神经球瘤的一种有用策略。在这个演示性手术视频中，手术技术和细微差别以逐步的方式进行了描述。视频链接可在：https://youtu.be/L0EosQK95LE 找到。
