Li Qiang, Yu Yanbing, Zhang Li, Liu Jiang, Ren Hongxiang, Zhen Xueke
Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Neurosurgery, Baotou Steel Group Third Staff Hospital, Baotou 014010, China.
Brain Sci. 2022 Sep 16;12(9):1257. doi: 10.3390/brainsci12091257.
Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild tinnitus, headache, and dizziness, together with preoperative related imaging, was diagnosed with a left intra-extracranial communicating jugular foramen lesion in November 2015 and accepted an initial operation for the intracranial tumor by retrosigmoid approach. The pathologic report was paraganglioma. In November 2021, a subtotal resection of the extracranial tumor was conducted for prominent lower cranial nerves (LCNs) deficit and middle ear involvement by infratemporal approach. In patients with IECJFP accompanied by LCNs deficit and middle ear involvement, an initial surgery for extracranial lesion and a second procedure for intracranial tumor were appropriate. However, the first operation for the intracranial lesion was preferred in IECJFP cases without LCNs deficit and middle ear involvement, as it could remove compression to the neurovascular structure and brain stem, clarify a pathological diagnosis, avoid a CSF leak, and prevent a severe neurological disorder from extracranial lesion excision. Subtotal resection of the extracranial tumor would be performed when lesion became larger combined with obvious LCNs disorder and tympanic cavity involvement. Consideration of specific staged surgical strategy for IECJFP in accordance with preoperative LCNs deficit and tympanic cavity involvement could prevent critical postoperative neurological deficit and improve quality of life in the long term.
分期手术策略适用于颅内外交通性颈静脉孔副神经节瘤（IECJFP）患者。一名女性患者出现轻度耳鸣、头痛和头晕，并伴有术前相关影像学检查，于2015年11月被诊断为左侧颅内外交通性颈静脉孔病变，并接受了经乙状窦后入路的颅内肿瘤初次手术。病理报告为副神经节瘤。2021年11月，因明显的低位颅神经（LCNs）功能障碍和中耳受累，通过颞下入路对颅外肿瘤进行了次全切除。对于伴有LCNs功能障碍和中耳受累的IECJFP患者，先进行颅外病变的初次手术，再进行颅内肿瘤的二次手术是合适的。然而，对于无LCNs功能障碍和中耳受累的IECJFP病例，首选对颅内病变进行初次手术，因为这样可以解除对神经血管结构和脑干的压迫，明确病理诊断，避免脑脊液漏，并防止因颅外病变切除导致严重的神经功能障碍。当病变增大并伴有明显的LCNs功能障碍和鼓室受累时，将进行颅外肿瘤的次全切除。根据术前LCNs功能障碍和鼓室受累情况考虑IECJFP的特定分期手术策略，可预防术后严重的神经功能缺损，并长期改善生活质量。
