Algorithm of Surgical Treatment of Patients with Temporal Bone Paraganglioma Preserving Anatomical Organization and Sound-Conducting Apparatus of the Middle Ear

Purpose. To improve functional results of surgical treatment in patients with temporal bone paraganglioma using a surgical access elaborated and implemented in otosurgeon’s practice. Materials and methods. For the period from February 2015 to February 2023, a total of 203 patients were examined and treated in the Federal State Budgetary Institution National Medical Research Center for Otorhinolaryngology. Volume and technique of surgery were determined depending on the degree of incidence of the tumor in accordance with U. Fisch and D. Mattox the classification modified by М. Sanna in 2013, as well as taking into account own experience. 203 patients with temporal bone paraganglioma were examined and operated: A type – 34 patients, among them 10 patients with A1 type, 24 patients with A2 type; B type – 89 patients, among them 25 patients with B1 type, 27 patients with B2 type, 37 patients with B3 type; C type – 80 patients, 34 patients with C1 type, 13 patients with C2 type, 8 patients with C3 type, 6 patients with C4 type. Of them, 34 were men and 96 were women aged between 28 and 82. Results. Outcomes in the immediate and long-term postoperative period in patients underwent the elaborated surgical access were appraised. All patients noticed improvement of hearing after surgery due to the increase of sound conduction threshold averagely to 10–15 dB. Selective embolization of the vessel feeding the tumor was conducted to all patients with B3 type tumor 24 hours before the surgery. Intraoperatively, patients after embolization demonstrated decreased tumor size and reduced bleeding from the tumor; the difference between extent of blood loss with and without embolization amounted to 100–150 ml. Facial nerve weakness in the immediate and long-term post-operative period was not observed. According to the data of imaging studies tumor recurrence after 6–12 months was not observed. Maximum observation period was 8 years. Conclusion. Suggested algorithm of surgical treatment of patients with temporal bone paraganglioma, based on the data of X-ray diagnostics on the pre-operative stage using endovascular embolization, navigation system, microsurgical technique and endovideocontrol, with the help of the elaborated surgical access, allows a complete removal of the neoplasm while preserving the vital structures of the middle ear and the lateral base of the skull. © 2023, Professionalnye Izdaniya. All rights reserved.