An update on the surgical treatment of temporal bone paraganglioma

In 1982, Fisch described his results for the surgical treatment of 74 parag angliomas of the temporal bone, 5 years after his description, of the infra temporal fossa approaches (types A and B). This study reviews the subsequen t experience of the Department of Otolaryngology-Head and Neck Surgery of t he University of Zurich with more than 136 surgically treated cases of para ganglioma of the temporal bone and discusses our current therapy 20 years a fter the initial description. One hundred nineteen (90%) of the patients ha d advanced tumors (Fisch class C or C + D), and 81 (68%) had intracranial e xtension. Total tumor excision was possible in 109 (82%) patients. Subtotal excision was performed in 22 (17%) patients, 21 of whom had intradural tum or invasion. In these cases, the resection was Limited not by actual tumor size but by the degree of intracranial intradural tumor extension. Partial tumor excision was undertaken in only 1 patient with a C4De2Di2 tumor. The success rate in preservation of function of the lower cranial nerves was en couraging. Of the 69 patients whose facial nerve status was followed postop eratively, 81% maintained Fisch grade 76 to 100% (House-Brackman grades I a nd II). Analysis of follow-up data ranging from 2 to 11 years demonstrated 98% disease-free survival when total tumor extirpation was possible. In the patients who underwent subtotal or partial surgical resection there has be en no-subsequent tumor growth detected by either clinical or neuroradiologi cal evaluation. We have confirmed after more than 20 years of experience th at the infratemporal fossa approaches are a safe, highly effective means of surgical management of paragangliomas of the temporal bone, allowing eradi cation or arrest of disease with minimal morbidity. Limited intradural surg ical resection in cases of very intensive tumors can greatly benefit: patie nts for whom complete excision is not an option.