Sanna Mario, Al-Khateeb Mohammed, Yilala Melcol Hailu, Almashhadani Mohanad, Fancello Giuseppe
Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, PC, Italy.
Department of ORL-HNS, Rizgary Teaching Hospital, Erbil 44001, Iraq.
Brain Sci. 2024 Jul 25;14(8):745. doi: 10.3390/brainsci14080745.
: to identify advanced or "so-called inoperable" cases of tympanojugular paragangliomas (PGLs) and analyze how each case is surgically managed and followed afterward. : a retrospective case series study. Out of 262 type C and D TJPs and more than 10 cases of advanced or so-called inoperable cases, files of 6 patients with a diagnosis of advanced tympanojugular PGLs who were referred to an otology and skull-base center between 1996 and 2021 were reviewed to analyze management and surgical outcomes. The criteria for choosing these cases involve having one or more of the following features: (1) a large-sized tumor; (2) a single ipsilateral internal carotid artery (ICA); (3) involvement of the vertebral artery; (4) a considerable involvement of the ICA; (5) an extension to the clivus, foramen magnum, and cavernous sinus; (6) large intradural involvement (IDE); and (7) bilateral or multiple PGLs. : The age range at presentation was 25-43 years old, with a mean of 40.5 years: two females and four males. The presenting symptoms were glossal atrophy, hearing loss, pulsatile tinnitus, dysphonia, shoulder weakness, and diplopia. The modified Infratemporal Fossa Approach (ITFA) with a transcondylar-transtubercular extension is the principal approach in most cases, with additional approaches being used accordingly. The contemporary introduction of carotid artery stenting with the direct and indirect embolization of PGLs has made it possible to operate on many cases, which was otherwise considered impossible to treat surgically. Generally, the key is to stage the removal of the tumor in multiple stages during the management of complex PGLs to decrease surgical morbidities. A crucial aspect is to centralize the treatment of PGLs in referral centers with experienced surgeons who are trained to plan the stages and manage possible surgical complications.
识别鼓室颈静脉副神经节瘤（PGLs）的晚期或“所谓无法手术”病例，并分析每个病例的手术处理方式及术后随访情况。方法：一项回顾性病例系列研究。在262例C型和D型鼓室颈静脉副神经节瘤以及10多例晚期或所谓无法手术的病例中，回顾了1996年至2021年间转诊至耳科学和颅底中心的6例诊断为晚期鼓室颈静脉副神经节瘤患者的病历，以分析治疗及手术结果。选择这些病例的标准包括具有以下一项或多项特征：（1）肿瘤体积大；（2）同侧单一颈内动脉（ICA）；（3）椎动脉受累；（4）颈内动脉大量受累；（5）向斜坡、枕骨大孔和海绵窦扩展；（6）大量硬脑膜内受累（IDE）；（7）双侧或多发PGLs。结果：就诊时年龄范围为25 - 43岁，平均40.5岁，2例女性，4例男性。主要症状为舌肌萎缩、听力丧失、搏动性耳鸣、声音嘶哑、肩部无力和复视。改良颞下窝入路（ITFA）联合髁突 - 结节旁扩展是大多数病例的主要入路，并根据情况采用其他辅助入路。当代颈动脉支架置入术以及PGLs的直接和间接栓塞术的引入，使得许多原本被认为无法手术治疗的病例得以进行手术。一般来说，关键在于在复杂PGLs的治疗过程中分阶段切除肿瘤，以降低手术并发症。一个关键方面是将PGLs的治疗集中在有经验丰富的外科医生的转诊中心，这些医生经过培训，能够规划手术阶段并处理可能的手术并发症。
