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. 2016 Dec 8;84(1):58-65.
doi: 10.1016/j.bjorl.2016.11.001. Online ahead of print.

Temporal bone paragangliomas: 15 years experience

Mehmet Düzlü  1 , Hakan Tutar  2 , Recep Karamert  2 , Furkan Karaloğlu  3 , Muammer Melih Şahin  2 , Mehmet Göcek  2 , Mehmet Birol Uğur  2 , Nebil Göksu  2
Affiliations

Temporal bone paragangliomas: 15 years experience

Mehmet Düzlü et al. Braz J Otorhinolaryngol. .

Abstract
in English, Portuguese

Introduction: Temporal bone paragangliomas (TBPs) are benign tumors arising from neural crest cells located along the jugular bulbus and the tympanic plexus. In general surgical excision, radiotherapy and wait-and-scan protocols are the main management modalities for TBPs.

Objective: In this paper we aim to present our clinical experience with TBPs and to review literature data.

Methods: The patients who were operated for tympanomastoid paraganglioma (TMP) or tympanojugular paraganglioma (TJP) in our clinic in the last 15 years were enrolled in the study. A detailed patient's charts review was performed retrospectively.

Results: There were 18 (52.9%) cases with TMPs and 16 (47.1%) cases with TJPs, a total of 34 patients operated for TBPs in this time period. The mean age was 50.3± 11.7 (range 25-71 years). The most common presenting symptoms were tinnitus and hearing loss for both TMPs and TJPs. Gross total tumor resection was achieved in 17 (94.4%) and 10 (62.5%) cases for TMPs and TJPs, respectively. Five patients (31.2%) with TJP experienced facial palsy following the operation. For all the patients the mean follow-up period was 25.8 months (range 4-108 months).

Conclusion: In conclusion, based on our findings and literature review, total surgical excision alone or with preoperative embolization is the main treatment modality for TBPs. However radiotherapy, observation protocol and subtotal resection must be considered in cases of preoperative functioning cranial nerves, large tumors and advanced age.

Introdução: Paragangliomas do osso temporal (POT) são tumores benignos derivados de células da crista neural localizadas ao longo do bulbo jugular e do plexo timpânico. Em geral, a excisão cirúrgica, a radioterapia e os protocolos de acompanhamento com estudos por imagem são as principais modalidades de conduta para o POT.

Objetivo: Apresentar nossa experiência clínica com POT e revisar os dados da literatura.

Método: Os pacientes que foram submetidos a cirurgia para paraganglioma timpanomastoideo (PTM) ou paraganglioma timpanojugular (PTJ) em nossa clínica nos últimos 15 anos foram incluídos no estudo. Realizou-se retrospectivamente uma revisão detalhada dos prontuários dos pacientes.

Resultados: Houve 18 (52,9%) casos com PTM e 16 (47,1%) casos com PTJ, portanto, um total de 34 pacientes operados para POT nesse período. A idade média foi de 50,3 ± 11,7 (intervalo de 25-71 anos). O sinais e sintomas de apresentação mais comuns foram o zumbido e perda auditiva, tanto para PTM quanto para PTJ. A ressecção tumoral completa foi obtida em 17 (94,4%) e 10 (62,5%) casos para PTM e PTJ, respectivamente. Cinco pacientes (31,2%) com PTJ apresentaram paralisia facial decorrente da cirurgia. Para todos os pacientes o tempo médio de seguimento foi de 25,8 meses (intervalo 4-108 meses).

Conclusão: Com base nos nossos dados e na revisão da literatura, a excisão cirúrgica total isolada ou com embolização pré-operatória é a principal modalidade de tratamento para POT. No entanto, a radioterapia, o protocolo de observação e a ressecção subtotal devem ser considerados no caso de nervos cranianos funcionais no pré-operatório, grandes tumores e idade avançada.

Keywords: Paraganglioma do osso temporal; Paraganglioma timpanojugular; Paraganglioma timpanomastóideo; Temporal bone paraganglioma; Tympanojugular paraganglioma; Tympanomastoid paraganglioma.

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Figures

Figure 1
Figure 1
A case of left sided TJP with typical salt and pepper appearance; meaning areas of high and low intensity on MRI. (A) An axial section of T1 weighted sequences. (B) A coronal section of T1 weighted fat suppressed sequences.
Figure 2
Figure 2
A case of TJP presented with HB grade 5 facial nerve palsy and undergone gross total tumor excision via IFTA-A approach after preoperative embolization. (A) Post-auricular incision with cervical extension. (B) Tumor extension is seen in hypotympanium during mastoidectomy. (C) Facial nerve is sacrificed which is invaded by tumor at stylomastoid foramen region. (D) Tumor originating from jugular bulbus. (E) CN 7–12 anastomosis.
See this image and copyright information in PMC

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