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Current Challenges and Advancements in Lateral Skull Base Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: 10 February 2026 | Viewed by 1390

Special Issue Editor


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Guest Editor
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Modena, 41125 Modena, Italy
Interests: otology; neurotology; lateral skull base; cochlear implant
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Special Issue Information

Dear Colleagues,

Lateral skull base lesions often require complex surgical removal, and their management is still extremely challenging and takes into account the patient’s age, hearing function, facial nerve and lower cranial nerves’ function and also the surgeon’s preference and experience. Currently, there is still a lack of guidelines even for some of the major lesions of the lateral skull base, mostly due to the rarity of these diseases. One example is the acoustic neuroma, one of the most frequent lateral skull base pathologies that has no definitive management recommendations. In fact, there are conflicting opinions in the literature on when to perform surgery and whether it should be hearing preserving or not, a gross total or subtotal resection, and when gamma knife stereotactic radiosurgery should be chosen instead.

This Special Issue will have the task of engaging experts in this field to report their experience in order to contribute to defining the management strategies to be adopted in this specific field of lateral skull base surgery.

Dr. Alessia Rubini
Guest Editor

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Keywords

  • lateral skull base
  • neurotology
  • jugular foramen
  • cerebellopontine angle
  • petrous apex
  • inner ear
  • acoustic neuroma
  • jugular paraganglioma
  • transtemporal approaches
  • infratemporal approaches

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Published Papers (2 papers)

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Research

15 pages, 1517 KB  
Article
A Multicenter Experience of the Treatment of Type Di Tympanojugular Paragangliomas: Total vs. Partial Resection and Residue Management
by Daniele Marchioni, Nicola Bisi, Mohamed Badr-El-Dine, George Wanna, Zachary G. Schwam, Mohamed Fawzy Fathalla and Alessia Rubini
J. Clin. Med. 2025, 14(18), 6579; https://doi.org/10.3390/jcm14186579 - 18 Sep 2025
Viewed by 169
Abstract
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 [...] Read more.
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’s relationship to critical structures. When residual tumor is present, both radiological surveillance and adjuvant radiotherapy can be effective strategies. Full article
(This article belongs to the Special Issue Current Challenges and Advancements in Lateral Skull Base Surgery)
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13 pages, 1639 KB  
Article
Clinical Outcome of Endoscopic and Endoscopic-Assisted Microscopic Removal of Glomus Tympanicum: A Multicenter Retrospective Study
by Waitsz Chang, Xiaoxin Chen, Mohamed Badr-El-Dine, Khalid Al Zaabi, Xinzhang Cai, Qi Wang, Nicolas Cornu, Romain Kania and Michael Chi Fai Tong
J. Clin. Med. 2025, 14(7), 2388; https://doi.org/10.3390/jcm14072388 - 31 Mar 2025
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Abstract
Objective: Comparing the clinical outcomes of glomus tympanicum (GT) resections by transcanal endoscopic ear surgery (TEES), microscopic- and endoscopic-assisted microscopic approaches. Methods: Adult patients conducting exclusive operations for GT within the tympanomastoid cavity were recruited in this retrospective cohort study at [...] Read more.
Objective: Comparing the clinical outcomes of glomus tympanicum (GT) resections by transcanal endoscopic ear surgery (TEES), microscopic- and endoscopic-assisted microscopic approaches. Methods: Adult patients conducting exclusive operations for GT within the tympanomastoid cavity were recruited in this retrospective cohort study at five international tertiary referral centers. GT resections were conducted by TEES, microscopic- and endoscopic-assisted microscopic approaches based on modified Fisch–Mattox classifications. Clinical characteristics and surgical outcomes were recorded and analyzed. Results: A total of 46 patients were included. A longer operative time was seen in more advanced GTs (A1: 106.73 ± 9.33 min, A2: 133.21 ± 13.47 min, B1: 176.88 ± 18.69 min, p = 0.005), while no significant differences were observed in the mean operative times among various surgical approaches. Preoperatively, 89.1% of patients experienced pulsatile tinnitus, and 56.5% exhibited conductive hearing loss. Postoperatively, only one patient continued to experience tinnitus (p < 0.001), and two patients had persistent hearing loss (p < 0.001). Higher disease grades correlated with poorer preoperative air-conduction thresholds (p = 0.015), while the differences in air-conduction thresholds before and after surgery did not demonstrate statistical significance across different tumor stages (p = 0.894) and surgical approaches (p = 0.257). The median follow-up period was 4 years, and only one recurrent case was found (2.2%, 1/46), which was treated by TEES and involved a B1 glomus tumor. Conclusions: Similar and excellent surgical outcomes were found among the TEES and microscope- and endoscopic-assisted microscopic approaches in early-stage GTs. Full article
(This article belongs to the Special Issue Current Challenges and Advancements in Lateral Skull Base Surgery)
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