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The advantages of staged resection of large glomus tumors were described by Avrim Eden, MD, and colleagues, of the Mount Sinai Medical Center, New York. Eight of 31 patients in this series had tumors with intracranial extension. These tumors could be classified as type D1 or D2 of the Fisch classification or as type II, III, or IV in the Glassock-Jackson classification of glomus tumors. The goals of the surgery were total tumor removal with minimal morbidity.
All patients underwent preoperative embolization to reduce hemorrhage during tumor resection. The intracranial extension was next managed via a suboccipital craniotomy. Once the temporal bone portion of the tumor was reached, a fascia/acrylic barrier was applied to the medial aspect of the tumor. Three to six weeks postoperatively, the mastoidectomy-neck portion of the dissection was undertaken for total tumor removal.
In contrast to the 10% to 22% rate of cerebrospinal fluid leaks reported