Technical Challenges in Temporal Bone Paraganglioma Surgery: a Clinical Review

Abstract

Temporal bone paragangliomas have always presented the otologist with their ultimate challenge. Surgical management is difficult, dangerous and demanding. It is also often associated with increased cranial nerve deficits and decreased quality of life for the patient. Management protocols for patients with temporal bone paragangliomas are changing as a result of advances in knowledge and technical developments. Multi-disciplinary care is now recommended for most patients with surgical intervention becoming restricted for the most difficult tumours. Previously considered unresponsive or resistant to radiotherapy, recent experiences using stereotactic radiosurgery techniques suggest that this is not correct. Tumour growth can be halted in some and slowed down in others. Advances in molecular medicine have defined a number of paraganglioma predisposition syndromes. Recognition of these syndromes is essential. Paragangliomas are now considered to be pioneer models of genetic-based personalised medical care. This review aims to define the best current management plan for paragangliomas arising in, or involving, the temporal bone. It alerts surgeons to critical phases of surgical technique.