A surgery by Dr. Luis Borba
At online surgery app SurgSchool, we present a top-level intervention performed by the renowned neurosurgeon Dr. Luis Borba, a skull base specialist. This surgery exemplarily illustrates the microsurgical treatment of multiple giant glomus tumors with complex extension towards the jugular foramen, the cerebellopontine angle, the middle ear and internal jugular vein.
Clinical case
Patient: 39-year-old male
The clinic: Headache, vertigo, tinnitus, hearing loss, dysphonia, left facial paralysis and lower nerve involvement
Diagnosis: Paraganglioma type tumors carotid glomus y glomus jugulare
Preoperative evaluation
La NMR y TC Preoperative examinations showed two highly vascularized masses: one in the left carotid bifurcation and another in the jugular foramen with intradural extension to the cerebellopontine angle, with bone erosions and involvement of the internal auditory canal, hypoglossal and petrous carotid arteries.
Surgical technique
Combined transtemporal retroauricular approach
- Retroauricular C-shaped incision with section of the external auditory canal due to tumor infiltration
- Retrolabyrinthine mastoidectomy to expose the sigmoid sinus, jugular bulb, petrous internal carotid artery, and facial nerve
- Identification and dissection of cranial nerves IX, X, XI, XII, as well as emissary veins, inferior petrosal sinus and carotid artery
- Ligation and opening of the internal jugular vein with tumor resection from within
- Intradural resection from the extension to the cerebellopontine angle
- Reconstruction skull base with temporal fascia, abdominal fat and anatomical closure by planes
Technical considerations
- En bloc resection of extradural and intradural lesions
- Use of greater auricular nerve graft for facial nerve reconstruction
- Vascular control from the beginning: common, external and internal carotid
- Preservation of critical neurovascular structures, even in a highly vascularized environment
Postoperative results
- Complete tumor resection confirmed by postoperative MRI
- Histological diagnosis: paragangliomas
- Facial evolution: Grade VI paralysis in the immediate postoperative period, with recovery to grade III during follow-up
- Functional improvement: vocal cord medialization to improve voice and swallowing
This microsurgical resection of giant glomus tumors represents an outstanding example of highly complex surgery at the skull base, with cutting-edge techniques applied by one of the international leaders in neurosurgery, Dr. Dr. Luis Borba.
