Facial nerve management in jugular paraganglioma surgery: a literature review

AbstractObjective:This literature review analysed facial nerve management strategies in jugular paraganglioma surgery and discusses the tumour resection rate and the facial nerve outcome associated with each technique.Methods:A retrospective review of PubMed and Medline articles on the surgical treatments for jugular paraganglioma was performed. Tumour resection rates and post-operative facial nerve function after non-rerouting, short anterior rerouting and long anterior rerouting approaches were evaluated for each article.Results:A total of 15 studies involving a total of 688 patients were included. Post-operative facial nerve function was similar after non-rerouting and short anterior rerouting approaches (p= 0.169); however, both of these techniques had significantly better post-operative facial nerve outcomes compared with long anterior rerouting (p< 0.001 andp= 0.001, respectively). The total tumour removal rate was significantly higher for long anterior rerouting than with the non-rerouting approach (p= 0.016). There was no difference in total tumour removal rate between the long and short anterior rerouting approaches (p= 0.067) and between the short anterior rerouting and non-rerouting approaches (p= 0.867).Conclusion:No strict guidelines for facial nerve management in jugular paraganglioma resection are available. Although long anterior rerouting provides the best tumour exposure along with a low morbidity rate, case-by-case selection of the surgical approach is recommended.