SAPHENOUS-VEIN GRAFT BYPASS OF THE SIGMOID SINUS AND JUGULAR BULB DURING THE REMOVAL OF GLOMUS-JUGULARE TUMORS - REPORT OF 2 CASES

Glomus jugulare tumors always invade the jugular bulb and sigmoid sinu s, making it difficult to resect these tumors totally without sacrific ing the involved sinus. Although the sinus can be sacrificed safely in most patients, a few patients will have serious consequences. Reconst ruction of the jugular bulb using a saphenous vein graft may enable tu mor resection in these patients without complications. The authors des cribe two cases of saphenous vein grafting used to bypass the sigmoid sinus. The first case is that of a 61-year-old man with a glomus jugul are tumor that invaded the dominant sigmoid sinus, which was poorly co llateralized. Temporary occlusion of the sinus during surgery caused a 15-mm Kg increase in intrasinus pressure, without brain swelling or c hanges in evoked potentials. A saphenous vein graft was used to bypass the sigmoid sinus and jugular bulb and to allow for total tumor remov al. The patient had a good outcome. The second case is that of a 41-ye ar-old man with a left glomus jugulare tumor and another smaller tumor on the opposite, dominant sinus. The left glomus jugulare tumor was r esected via a two-stage procedure. A saphenous vein graft was used to reconstruct the left sigmoid sinus because of the presence of contrala teral disease, with the potential for bilateral sigmoid sinus occlusio n. An evaluation of the venous collateral circulation during jugular f oramen surgery and the prevention of complications are also discussed.