Management of large bilateral glomus jugulare tumors

Bilateral glomus jugulare tumors are rare. However, their treatment should preserve not only the function of the facial nerve but also the caudal cran ial nerves and the middle ears in order to avoid bilateral hearing losses. Further, venous cerebral drainage has to be ensured in order to avoid cereb ral hypertension and hemorrhagic infarction after bilateral jugular ligatio ns. In the case presented bilateral glomus jugulate tumors required super-s elective angiography and embolization. Complete tumor removal on both sides was then possible by a transmastoid-transcervical approach without any fur ther functional deteriorations. Middle ear function was preserved on both s ides by temporary ventral translocation of the posterior wall of the audito ry meatus. As the sigmoid sinus and internal jugular vein had been ligated during initial previous surgery, venous drainage was tested one year later by angiography and compression of the remaining internal jugular vein. A su fficient collateral circulation was found and permitted surgery on the seco nd side.