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nlm-article

Nickalus R. Khan, Clifford S. Brown, Simon Angeli, and Jacques J. Morcos

The authors present the case of a 34-year-old patient with neurofibromatosis type 2 (NF-2) who underwent a left translabyrinthine approach for resection a meningioma, vestibular schwannoma, and placement of an auditory brainstem implant (ABI). They review the preoperative workup, technical nuances of the surgery, and cadaveric dissections with anatomical diagrams, and provide a review on ABIs. The patient remained neurologically intact and had improvement in lip reading when using the ABI device in the postoperative period.

The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2163

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nlm-article

Brandon G. Gaynor, Mohamed Samy Elhammady, Daniel Jethanamest, Simon I. Angeli, and Mohammad A. Aziz-Sultan

Object

The resection of glomus jugulare tumors can be challenging because of their inherent vascularity. Preoperative embolization has been advocated as a means of reducing operative times, blood loss, and surgical complications. However, the incidence of cranial neuropathy associated with the embolization of these tumors has not been established. The authors of this study describe their experience with cranial neuropathy following transarterial embolization of glomus jugulare tumors using ethylene vinyl alcohol (Onyx, eV3 Inc.).

Methods

The authors retrospectively reviewed all cases of glomus jugulare tumors that had been treated with preoperative embolization using Onyx at their institution in the period from 2006 to 2012. Patient demographics, clinical presentation, grade and amount of Onyx used, degree of angiographic devascularization, and procedural complications were recorded.

Results

Over a 6-year period, 11 patients with glomus jugulare tumors underwent preoperative embolization with Onyx. All embolization procedures were completed in one session. The overall mean percent of tumor devascularization was 90.7%. No evidence of nontarget embolization was seen on postembolization angiograms. There were 2 cases (18%) of permanent cranial neuropathy attributed to the embolization procedures (facial nerve paralysis and lower cranial nerve dysfunction).

Conclusions

Embolizing glomus jugulare tumors with Onyx can produce a dramatic reduction in tumor vascularity. However, the intimate anatomical relationship and overlapping blood supply between these tumors and cranial nerves may contribute to a high incidence of cranial neuropathy following Onyx embolization.