(0951) Novel Use of Silicone Elastomer (Silastic) in Older Patients Undergoing Resection of Jugular Foramen Paragangliomas

Introduction: Jugular foramen paragangliomas are the most common tumors of the jugular foramen, and while patients often present with hearing loss and pulsatile tinnitus, cranial nerve deficits including facial nerve paralysis also occur. We describe a novel use of silicone elastomer (silastic) to prevent further tumor invasion into the facial nerve in elderly patients with symptomatic facial nerve involvement who undergo subtotal surgical resection of these tumors.

Methods: We developed a novel surgical technique for large jugular foramen paragangliomas to slow the progression of facial paralysis in elderly patients with facial nerve deficits undergoing resection of these tumors. Patients underwent a partial resection via a post-auricular infratemporal fossa approach with as much debulking of the tumor from the facial nerve as possible, while leaving the nerve intact. A plane was established between the lateral wall of the tumor and the medial wall of the facial nerve and a piece of silastic was placed in this position to prevent further invasion of the tumor into the nerve.

Results: This technique was carried out in 5 surgeries in this unique patient population (age range: 75-82) over an 8-year time period (2015-2023). These patients have had no further progression of facial nerve deficits during the follow-up period despite tumor growth in some individuals.

Conclusions: Preventing further invasion of large jugular foramen paragangliomas into the facial nerve after partial resection is possible with the placement of silastic stenting between the tumor and the nerve. This technique is useful in elderly or medically complex patients who are not ideal candidates for total resection due to the possibility of lower cranial nerve deficits and complete facial paralysis.