Glomus jugulare tumor surgery with intracranial extension.

Total surgical excision of a glomus jugulare tumor is the treatment of choice for this benign tumor. If the tumor has extended beyond the temporal bone into the intracranial spaces, most often the posterior fossa, the surgical excision becomes more difficult. If the tumor has extended anteriorly and posteriorly into the posterior fossa or if a portion of the tumor is exposed in the external auditory canal with the concurrent infection that is seen with this presentation, the intracranial portion of the tumor should be removed as a first step in a planned two-stage removal of the tumor. If the intracranial extension is limited and there is no infection present with the tumor, a combined otologic-neurosurgical approach using transtemporal and suboccipital access to the temporal bone will allow successful total removal of the tumor in a one-stage procedure. Details are presented to demonstrate this combined otologic and neurosurgical approach to large glomus tumors with intracranial extension.