{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:44:52Z","timestamp":1760060692802,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Tympanojugular paragangliomas (TJ-PGs) showing intradural growth into the cerebellopontine angle (Fisch classification Di) represent a surgical challenge, with their proper surgical management still under debate. Methods: This is an international multicenter retrospective review of patients with Di TJ-PGs who underwent surgery in three high-volume skull base surgery centers. We aimed to establish practice patterns for treating Di TJ-PGs, namely the surgical approach, total versus partial resection, and whether a staged procedure was needed. We also examined the status of the facial and lower cranial nerves (LCNs), postoperative complications, and residue management after partial resection. Results: Thirty-two patients were included in this study with an average follow-up of 66 months. Preoperative angiography with selective embolization was performed in all patients, and a type A infratemporal fossa approach was the most common surgical technique. Total resection was achieved in 16 cases. A single-stage procedure was performed in 26 patients and a staged procedure in 6. CSF leakage in the neck was the main reported complication. Most patients had an HB I-II-grade facial nerve at the last follow-up, and three patients experienced worsened lower cranial neuropathies. In 16 patients residual disease was present after surgery and was managed with either radiotherapy or observation. Conclusions: Di TJ-PGs pose a complex treatment challenge for which clear-cut management recommendations have not been established. Surgical resection, when indicated, may be total, the preferred option in young healthy candidates, or partial, mainly employed in elderly or high-risk patients, always considering the tumor\u2019s relationship to critical structures. When residual tumor is present, both radiological surveillance and adjuvant radiotherapy can be effective strategies.<\/jats:p>","DOI":"10.3390\/jcm14186579","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T12:54:26Z","timestamp":1758200066000},"page":"6579","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Multicenter Experience of the Treatment of Type Di Tympanojugular Paragangliomas: Total vs. Partial Resection and Residue Management"],"prefix":"10.3390","volume":"14","author":[{"given":"Daniele","family":"Marchioni","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9029-8530","authenticated-orcid":false,"given":"Nicola","family":"Bisi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6480-6538","authenticated-orcid":false,"given":"Mohamed","family":"Badr-El-Dine","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Wanna","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary G.","family":"Schwam","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4705-7293","authenticated-orcid":false,"given":"Mohamed Fawzy","family":"Fathalla","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Suez University, Suez 41522, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Rubini","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/00129492-200105000-00018","article-title":"Lateral Skull Base Surgery for Glomus Tumors: Long-Term Control","volume":"22","author":"Jackson","year":"2001","journal-title":"Otol. Neurotol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1177\/000348948209100502","article-title":"Infratemporal Fossa Approach for Glomus Tumors of the Temporal Bone","volume":"91","author":"Fisch","year":"1982","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.3171\/jns.1994.80.6.1026","article-title":"Combined approaches for resection of extensive glomus jugulare tumors: A review of 12 cases","volume":"80","author":"Patel","year":"1994","journal-title":"J. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"083","DOI":"10.1055\/s-0028-1103125","article-title":"Evolving Concepts in the Management of Jugular Paraganglioma: A Comparison of Radiotherapy and Surgery in 88 Cases","volume":"19","author":"Huy","year":"2009","journal-title":"Skull Base"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/0090-3019(87)90224-2","article-title":"A combined infratemporal and posterior fossa approach for the removal of giant glomus tumors and chondrosarcomas","volume":"28","author":"Fox","year":"1987","journal-title":"Surg. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1055\/s-0032-1312707","article-title":"Surgical Management of Giant Transdural Glomus Jugulare Tumors with Cerebellar and Brainstem Compression","volume":"73","author":"Carlson","year":"2012","journal-title":"J. Neurol. Surg. B"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1097\/00129492-200409000-00025","article-title":"Management of Jugular Paragangliomas: The Gruppo Otologico Experience","volume":"25","author":"Sanna","year":"2004","journal-title":"Otol. Neurotol."},{"key":"ref_8","first-page":"7","article-title":"Glomus tumors of the temporal region: Surgical therapy","volume":"1","author":"Oldring","year":"1979","journal-title":"Am. J. Otol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1288\/00005537-199211000-00001","article-title":"Defect reconstruction and cerebrospinal fluid management in neurotologic skull base tumors with intracranial extension","volume":"102","author":"Jackson","year":"1992","journal-title":"Laryngoscope"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1002\/hed.25567","article-title":"Update in the classification and the role of intra-arterial stenting in the management of carotid body paragangliomas","volume":"41","author":"Prasad","year":"2019","journal-title":"Head Neck"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1097\/00129492-200407000-00026","article-title":"Transjugular Craniotomy for the Management of Jugular Foramen Tumors with Intracranial Extension","volume":"25","author":"Oghalai","year":"2004","journal-title":"Otol. Neurotol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.3171\/jns.2002.97.6.1356","article-title":"Complex tumors of the glomus jugulare: Criteria, treatment, and outcome","volume":"97","author":"Teixeira","year":"2002","journal-title":"J. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1227\/01.NEU.0000163483.44754.47","article-title":"Tumors of the Jugular Foramen: Diagnosis and Management","volume":"57","author":"Ramina","year":"2005","journal-title":"Oper. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3171\/foc.2004.17.2.7","article-title":"Glomus jugulare tumors with intracranial extension","volume":"17","author":"Jackson","year":"2004","journal-title":"Neurosurg. Focus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1001\/archotol.1981.00790400011002","article-title":"Glomus Tumors of the Temporal Region: Technique of Surgical Resection","volume":"107","author":"Jenkins","year":"1981","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1177\/019459988008800504","article-title":"Glomus Jugulare Tumor Surgery with Intracranial Extension","volume":"88","author":"Kinney","year":"1980","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1159\/000338418","article-title":"Surgical Management of Tympanojugular Paragangliomas with Intradural Extension, with a Proposed Revision of the Fisch Classification","volume":"17","author":"Sivalingam","year":"2012","journal-title":"Audiol. Neurotol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1055\/s-2007-1016957","article-title":"Intradural Jugular Paragangliomas: Complications and Sequelae","volume":"18","author":"Magliulo","year":"2008","journal-title":"Skull Base"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.otc.2006.04.004","article-title":"Revision Glomus Tumor Surgery","volume":"39","author":"Sanna","year":"2006","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2478312","DOI":"10.1080\/07853890.2025.2478312","article-title":"Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas","volume":"57","author":"Luo","year":"2025","journal-title":"Ann. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6579\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:05Z","timestamp":1760035685000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6579"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":20,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186579"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186579","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}