Jugulotympanic paraganglioma, preoperative embolization, and transmastoid retrolabyrinthine approach: Two-dimensional operative video.

BACKGROUND

Jugulotympanic paraganglioma (JTP), also known as glomus jugulare tumor, is a neuroendocrine neoplasm. Although it represents <0.5% of head-and-neck tumors, it demonstrates significant local aggressiveness due to its tendency to infiltrate bone, vascular structures, and cranial nerves. Due to the hypervascular nature of these tumors, preoperative embolization has become an important surgical adjunct. The retrolabyrinthine approach provides adequate exposure of the jugular foramen while preserving the facial nerve without mandatory transposition.

CASE DESCRIPTION: We present a 52-year-old woman with hearing loss, tinnitus, and dizziness. Evaluation revealed left-sided anacusis secondary to prior cochlear dysfunction and severe conductive hearing loss. Computed tomography showed extensive erosion of the jugular foramen without carotid canal, labyrinth, or internal auditory canal involvement. Magnetic resonance imaging (MRI) demonstrated a Fisch D1 lesion with cisternal and extracranial extension, measured 30 × 18 × 22 mm along its craniocaudal, anteroposterior, and laterolateral axes, respectively, with an estimated volume of 5.94 cm3. After multidisciplinary discussion, preoperative embolization of external carotid branches achieved >50%, followed by a transmastoid retrolabyrinthine approach for resection. Estimated blood loss was 2500 mL. In the postoperative course, the patient had House-Brackmann grade I facial function, moderate dysphagia, and mild dysphonia. A 3-month postoperative MRI shows expected postoperative changes and no evidence of residual tumor.

CONCLUSION

Preoperative embolization facilitates surgical resection in advanced JTP. Combined with meticulous technique and neuromonitoring, it enables favorable functional outcomes and cranial nerve preservation.