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The first 25 slides, exactly as they appear. The full deck has 57 content slides.
Neurosurgery
Surgical Management of Intracranial Glomus Jugulare Tumors
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
6 sections · 57 slides
The Tumor and the Problem
Where glomus jugulare tumors come from and why they are hard to remove
- What is a glomus jugulare tumor?
- Why it is a formidable surgical challenge
- CT of a destructive left jugular foramen tumor
- Contrast MRI of an enhancing jugular foramen mass
- How modern management evolved
- Four management options at a glance
Choosing the Right Patient and Plan
Matching the treatment to the tumor and the person
- Risk factors the team weighs
- Whom to observe versus whom to treat
- Subtotal versus gross total resection
Preoperative Work-Up
Mapping the anatomy, the blood supply, and the hormones before touching the tumor
- Imaging the bone and soft tissue
- Four-vessel cerebral angiography: the definitive study
- Vascular blush of the tumor on carotid injection
- Reading the venous phase
- Assessing the carotid artery
- Preoperative superselective embolization
- Catecholamine-secreting tumors
- Other preoperative checks
Anesthesia and Positioning
Setting up a long, multi-team operation safely
- Goals of anesthesia and monitoring
- Blood pressure control around surgery
- Patient positioning for the operation
- Two goals of positioning
- Deciding when to remove the breathing tube
Operative Approaches
Tailoring the exposure to the size of the tumor and the need for carotid control
- Three approaches, chosen by tumor extent
- High cervical exposure: the incision
- Isolating the vessels and nerves
- Landmarks and 270-degree jugular vein control
- 270-degree exposure of the jugular vein
- Temporal bone exposure: mastoidectomy
- Mobilizing and protecting the facial nerve
- Gaining control of the distal carotid artery
- Tumor removal: securing the venous outflow first
- Facial nerve transposed and jugular vein ligated
- Silk ligature passed around the sigmoid sinus
- Piecemeal removal, sparing the nerves
- Tumor removal preserving the jugular bulb medial wall
- Handling the dura and preventing CSF leak
- Wound closure
- Abdominal fat graft and flap closure
- Modified lateral skull base approach
- Modified lateral skull base exposure
- Infratemporal fossa approach
Postoperative Management
Aggressively managing the complications that decide the outcome
- Cranial nerve palsy: the central risk
- Managing lower cranial nerve loss and aspiration
- Recovery of swallowing and speech
- Facial nerve palsy and protecting the eye
- CSF leakage and wound healing
- CSF dynamics and hydrocephalus
- Vascular injury to the carotid artery
- Key takeaways
- Neurosurgical Operative Atlas: Neuro-Oncology