Tumor Surgery

Abstract

• The most common benign tumors in the TB are the vestibular schwannoma (acoustic neuroma) and the paraganglioma (glomus tumor).

• Other benign tumors of the internal auditory canal include meningioma, epidermoid, lipoma, and arachnoid cyst. Additional benign tumors in the middle ear include adenoma, carcinoid, chondroma, and schwannoma.

• Treatment of vestibular schwannoma may be nonsurgical (irradiation) or surgical. In the medically stable young patient, surgery is preferred, while irradiation is effective in the elderly or medically compromised patient.

• Surgical approach to vestibular schwannoma may utilize either the posterior or middle cranial fossa. Posterior fossa approach may be transmastoid translabyrinthine (no hearing) or suboccipital (hearing preservation). The middle fossa approach is employed for tumors limited to the internal auditory canal, where hearing is to be preserved.

• Glomus tumors may be limited to the middle ear space (glomus tympanicum) or arise in the jugular bulb and extend to the middle ear, mastoid, neck and other perilabyrinthine compartments (glomus jugulare).

• Glomus tympanicum tumors are best removed through an endaural surgical approach.

• Glomus jugulare tumors require an extended lateral skull base approach including the neck and wide TB exenteration. Preoperative endovascular embolization is not effective in reducing blood loss.

• Partial (lateral) TB resection is an effective surgical procedure for carcinoma limited to the external auditory canal.

• Pseudoepithelial hyperplasia may simulate squamous cell carcinoma of the ear canal clinically and histopathologically.