Glomus jugulare surgery
by Cassio Zothis Grapiglia

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

This video demonstrates the surgery for a glomus jugulare tumor. It is important to identify and gain control over the vessels in the neck prior to performing a subtotal petrosectomy and excising the tumor. Comprising a complex region, the jugular foramen involves nerves, sinus cavities, dural folds and osseous structures. Not only the complex anatomy of this region, but also the difficult approach to this area converts the foramen’s pathologies into a real challenge for the neurosurgeon. Preoperative embolization is described in literature. However, the authors do not use this method in all the cases, since, in their experience, embolization may cause nerve dysfunction due to increase in density of the tumor, making resection an arduous process. Also, sometimes, partial embolization may have worse results as the tumor is modified and still highly vascularized. They reserve embolization for D2 or D3 tumors by the Fisch classification, or in those cases presenting with lower cranial nerve defecits. Five crucial points in the management of Glomus tumors as advocated by the authors include: (i) early vascular control of ICA and ECA; (ii) identification and ligation of the affected vessels; (iii) proximal control of the sigmoid sinus and the IJV; (iv) identification and preservation of lower cranial nerves and facial nerve; (v) obliteration and reconstruction of the surgical cavity.

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