Preoperative embolization of the inferior petrosal sinus in surgery for glomus jugulare tumors

To compare the outcomes of surgery for glomus tumors involving the jugular foramen with and without preoperative venous embolization of the inferior petrosal sinus (IPS). Retrospective chart review. Tertiary referral center. Twenty-four patients with paragangliomas involving the jugular foramen treated between 1995 and 2008. All patients underwent surgical resection after receiving preoperative angioembolization with or without venous embolization of the IPS. Total operative duration, estimated blood loss, intensive care unit and total hospital days, and novel postoperative lower cranial nerve deficits were recorded, and appropriate statistical analysis was conducted. Twenty-four patients met inclusion criteria. Fourteen of these patients underwent preoperative embolization of the IPS in addition to angioembolization. The group that did not undergo embolization of the IPS was used as the control group (n = 10). These groups were compared with regard to the above outcome measures. Blood loss and new lower cranial nerve deficits were reduced in the venous embolization group, although neither measure reached statistical significance. Tumor size correlated with increased intraoperative hypotensive events and longer total hospital stay, and these correlations were statistically significant. Preoperative embolization of the IPS is possible in many patients undergoing surgery of the jugular foramen. The addition of venous embolization to the traditional arterial embolization of glomus jugulare tumors adds little additional time or expense to the procedure and facilitates control of bleeding once the jugular bulb has been opened.