Surgical management of tympanojugular paragangliomas: a rare and challenging case of vascular neoplasm

Abstract

Tympanojugulare paragangliomas (TJPs) have always been a challenge for surgeons because these tumors are vascularized and locally aggressive and involve essential neurovascular structures. In this study, we present the case of a 54-year-old woman with a mass in the right ear canal associated with pulsatile tinnitus, hearing impairment, and multiple lower cranial nerves palsy (CN VII, XI, and XII). The clinical manifestations and paraclinical investigations established the diagnosis of tympanojugulare paraganglioma Fisch B2. According to the preoperative plan of the case, we decided to resect the tumor subtotally with the canal wall down mastoidectomy procedure. The postoperative evaluation shows good healing and improvement of all the symptoms. Finally, the tympanojugulare paraganglioma tends to involve multiple vital skull base structures with surgery remains the mainstay treatment. A detailed preoperative treatment plan is required to maximize tumor resection, minimize the morbidity of the great vessels and lower cranial nerves, and optimize the result.

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