Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4991
Peer-review started: November 8, 2021
First decision: February 7, 2022
Revised: March 3, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 26, 2022
Processing time: 197 Days and 10.2 Hours
Paraganglioma occurring at the lateral skull base is a rare tumor. Surgery is the primary treatment of benign paragangliomas. Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage.
A 30-year-old man with a 1-year history of left-side progressive hearing loss, tinnitus, facial palsy, and choking failed conventional treatment and is the focus of this case report. Imaging revealed a mass around the left jugular foramen that was approximately 47 mm × 38 mm × 34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery. The tumor breached the meninges and occupied the cerebella pontine region. A two-stage surgery was designed for the resection of the mass. In the first-stage, the epidural portion of the mass was removed. The abdominal fat and the temporal muscle flap were transposed within the surgical site. The surgery was successful; however, 25 d after surgery, he developed suppurative parotitis, and the infection spread to the surgical site at the skull base. Broad-spectrum antibiotics were used, and debridement was deployed. After that, the wound was cleaned daily. Five months after the first-stage surgery, the wound was still unclosed, and there was intermittent purulent exudation within the surgical site. vacuum sealing drainage (VSD) was used, and the wound healed in a month. One year after the first surgery, the second-stage of the operation was performed to remove the intracranial portion of the tumor. Recurrence of the tumor was not detected after a 6-month follow-up.
After a lateral skull base surgery, suppurative parotitis can spread into the operative cavity leading to infection of the surgical site. VSD can help to effectively heal the infected wound. A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.
Core Tip: This is a case report of a 30-year-old male patient with a left jugular foramen paraganglioma who underwent first-stage surgical resection of the epidural portion of the tumor. On postoperative day 25, he developed fever, swelling, and tenderness under the left ear. Investigation and retrospective analyses revealed an infection of the skull base surgical site caused by pseudomonas aeruginosa, due to postoperative suppurative parotitis. The infection was successfully treated with vacuum sealing drainage and antibiotic therapy. The second-stage operation took place 6 mo later, and tumor recurrence was not detected after a 6-month follow-up.