Postauricular Transcanal Posterior Tympanectomy (PT²) Approach – A Modified Surgical Technique for Jugulotympanic Paragangliomas

Abstract

Introduction

The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors.

Objective

To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas.

Methods

This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypo-tympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients.

Results

The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy.

Conclusions

Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.

Keywords
Glomus tympanicum; Surgical approach; modified surgical technique