Jugulotympanic paragangliomas: 75 years of evolution in understanding

Forbes, Jonathan A.; Brock, Andrea A.; Ghiassi, Mayshan; Thompson, Reid C.; Haynes, David S.; Tsai, Betty S.

doi:10.3171/2012.6.focus12138

Cited by 30 publications

(26 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early on, large catheters combined with bulkier embolic agents hindered efforts to selectively catheterize tumor feeders beyond the tertiary ECA branches. 4 Since modern techniques have been adopted, these tumors have been embolized with materials including polyvinyl alcohol (PVA), Gelfoam, N-butyl cyanoacrylate, microcoils, and Onyx. …”

Section: Discussionmentioning

confidence: 99%

“…9,11,21 Historically, early attempts at resection have been impeded by challenging anatomical tumor location, complex tumor anatomy, and robust tumor vascularity that causes excessive blood loss during resection. 4,15 Preoperative embolization was introduced in the 1970s. 7 The goal was to minimize blood flow to the tumor and thereby decrease blood loss and enable better visualization of surgical planes, which increases the likelihood of gross-total resection and minimizes nerve injury.…”

Section: Discussionmentioning

confidence: 99%

“…As early as 1975, preoperative embolization before resection has been advocated as a means to improve postoperative outcomes through the minimization of blood loss and better visualization of surgical planes. 4,7 Given its flow characteristics, Onyx (Covidien) has seen increasing use in the preoperative embolization of tumors, including paragangliomas. 1,3,5,6,17,20,25 Direct percutaneous puncture is currently the most reported route for Onyx embolization of these tumors, although it is unclear whether that reflects a publication bias or if this modality is actually more common than using transarterial routes of embolization.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Initial experience with dual-lumen balloon catheter injection for preoperative Onyx embolization of skull base paragangliomas

Ladner

He²,

Davis³

et al. 2016

JNS

View full text Add to dashboard Cite

P aragangliomas are highly vascular head and neck tumors. As early as 1975, preoperative embolization before resection has been advocated as a means to improve postoperative outcomes through the minimization of blood loss and better visualization of surgical planes. 4,7 Given its flow characteristics, Onyx (Covidien) has seen increasing use in the preoperative embolization of tumors, including paragangliomas. 1,3,5,6,17,20,25 Direct percutaneous puncture is currently the most reported route for Onyx embolization of these tumors, although it is unclear whether that reflects a publication bias or if this modality is actually more common than using transarterial routes of embolization. 3,17,20,25 Problems with conventional transfemoral artery access, such as tortuosity, atherosclerosis, vasospasm, and small-caliber arterial feeders, may impede complete embolization of these tumors, and dangerabbreviatioNs EBL = estimated blood loss; ECA = external carotid artery; ICA = internal carotid artery; PVA = polyvinyl alcohol. obJective Paragangliomas are highly vascular head and neck tumors for which preoperative embolization is often considered to facilitate resection. The authors evaluated their initial experience using a dual-lumen balloon to facilitate preoperative embolization in 5 consecutive patients who underwent preoperative transarterial Onyx embolization assisted by the Scepter dual-lumen balloon catheter between 2012 and 2014. methods The authors reviewed the demographic and clinical records of 5 patients who underwent Scepter-assisted Onyx embolization of a paraganglioma followed by resection between 2012 and 2014. Descriptive statistics of clinical outcomes were assessed. results Five patients (4 with a jugular and 1 with a vagal paraganglioma) were identified. Three paragangliomas were embolized in a single session, and each of the other 2 were completed in 3 staged sessions. The mean volume of Onyx used was 14.3 ml (range 6-30 ml). Twenty-seven vessels were selectively catheterized for embolization. All patients required selective embolization via multiple vessels. Two patients required sacrifice of parent vessels (1 petrocavernous internal carotid artery and 1 vertebral artery) after successful balloon test occlusion. One patient underwent embolization with Onyx-18 alone, 2 with Onyx-34 alone, and 1 with Onyx-18 and -34. In each case, migration of Onyx was achieved within the tumor parenchyma. The mean time between embolization and resection was 3.8 days (range 1-8 days). Gross-total resection was achieved in 3 (60%) patients, and the other 2 patients had minimal residual tumor. The mean estimated blood loss during the resections was 556 ml (range 200-850 ml). The mean postoperative hematocrit level change was -17.3%. Two patients required blood transfusions. One patient, who underwent extensive tumor penetration with Onyx, developed a temporary partial cranial nerve VII palsy that resolved to House-Brackmann Grade I (out of VI) at the 6-month follow-up. One patient experienced improvement in existing faci...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Initial experience with dual-lumen balloon catheter injection for preoperative Onyx embolization of skull base paragangliomas

Ladner

He²,

Davis³

et al. 2016

JNS

View full text Add to dashboard Cite

show abstract

“…Paragangliomske celice pa izvirajo iz nevroektoderma in niso povezane s temi arterio-venskimi malformacijami (6,7).…”

Section: Opredelitevunclassified

Zdravljenje jugularnih paragangliomov v UKC Maribor

Rebol¹,

Lanišnik²,

Ravnik³

et al. 2017

SlovMedJour

View full text Add to dashboard Cite

IzvlečekIzhodišče: Jugularni paragangliomi so redki, skoraj vedno benigni, počasi rastoči tumorji. Vzniknejo iz paraganglijskih celic jugularnega bulbusa, nato pa infiltrativno vraščajo v temporalno kost, v poznejši fazi pa rastejo tudi intrakranialno. Zaradi prikrite rasti jih odkrijemo sorazmerno pozno. Ob predstavitvi bolniki najpogosteje navajajo leta trajajoč pulzirajoči tinitus in naglušnost, pogosto pa imajo tudi pareze možganskih živcev, ki potekajo v področju rasti tumorja -to so VII., IX., X., XI. in XII. živec. Kirurška resekcija je standard zdravljenja, ki pa je zaradi težke dostopnosti lateralne lobanjske baze in vitalnih struktur na njej tehnično zahtevna. Potrebna je timska obravnava otorinolaringologa, interventnega radiologa in nevrokirurga. Namen članka je pregled kliničnih izkušenj z zdravljenjem jugularnih paragangliomov na Oddelku za otorinolaringologijo in maksilofacialno kirurgijo UKC Maribor.Metode: Pregledali smo dokumentacijo desetih bolnikov z jugularnim paragangliomom, ki smo jih v zadnjih 15 letih obravnavali na našem oddelku, ter njihovo klinično pot predstavili v tabeli.Rezultati: Devet jih je bilo operiranih, pri vseh je bila pred operacijo opravljena embolizacija tumorja. Pri eni bolnici je bila operacija kontraindicirana zaradi izrazito dominantne venske drenaže na strani tumorja in aplastičnosti transverznega sinusa na kontralateralni strani. Zdravljena je bila primarno z obsevanjem. Adjuvantno radioterapijo je prejela bolnica, pri kateri zaradi intrakranialnega vraščanja tumorja nismo dosegli totalne resekcije. 60 % bolnikov je imelo ob predstavitvi parezo spodnjih možganskih živcev, pri ostalih, ki pa je niso imeli, smo jih pri odstranitvi tumorja uspeli ohraniti. Funkcija obraznega živca se je po anteriorni prestavitvi praktično normalizirala pri vseh bolnikih. Naknadno smo našim bolnikom nudili tudi rehabilitacijo in korekcijske posege, kot sta npr. medializacija glasilke in kostni slušni pripomoček BAHA.Zaključek: Kljub tveganosti s posegom učinkovito preprečimo napredovanje bolezni in nove primanjkljaje možganskih živcev. Rezultati našega dela kažejo, da nudimo bolnikom s to težko boleznijo dobro in celovito oskrbo. AbstractBackground: Jugular paragangliomas are rare, almost exclusively benign and slowly growing tumors. Arising from the cells of paraganglia in jugular bulb, they infiltrate the temporal bone and later grow intracranially. Because of insidious onset, their diagnosis is relatively late. Patients at presentation usually complain of pulsatile tinnitus and hearing loss, lasting for years. Also common are palsies of the cranial nerves in the area of tumor growth -i.e., facial, glossopharyngeal, vagal, accessory and hypoglossal nerves. Surgical resection is the standard treatment, though technically demanding because of difficult approach to the lateral cranial base and vital structures in the area. The team for treating such patients comprises an ENT specialist, interventional radiologist and a neurosurgeon. The purpose of this article is to review clinical expe...

show abstract

“…These highly vascular tumors of neural crest cell origin may also secrete catecholamines causing autonomic instability [2]. The most common locations of these tumors are at the inferior ganglion of the vagus nerve (glomus vagale), carotid artery bifurcation (carotid body), jugular fossa (glomus jugulare), and middle ear (glomus tympanicum) [3]. Although surgery has historically been used as the primary treatment modality for SBP, radiation therapy has also been used as a definitive treatment of these tumors without operative risks [4,5].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of Tumor Volumetric Responses to Five-Fraction Stereotactic Radiotherapy for Paragangliomas of the Head and Neck (Glomus Tumors)

Chun

Nedzi

Choe

et al. 2014

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Background: Skull base paragangliomas (SBP) are locally expansile tumors that can be treated with stereotactic radiotherapy with favorable results. This report describes the results of 31 patients with SBP treated with CyberKnife radiotherapy delivering a total dose of 25 Gray in five fractions. Methods: All patients treated with five-fraction CyberKnife radiotherapy at a single institution were identified between 2007 and 2013. Tumor volumetric analyses were performed to assess responses to radiotherapy. Results: Median follow-up was 24 months with a range of 4-78 months. Local control and overall survival were 100%. Of the 20 patients who presented with tinnitus, 12 reported improvement (60%), of whom 6 reported complete resolution. There was a 37.3% reduction in tumor volume among all patients (p = 0.16). On subset analysis of patients with ≥24 months of follow-up, tumor volume decreased 49% (p = 0.01). The rate of grade 1-2 toxicity was 19%, with no grade 3 or worse toxicity. Conclusion: A five-fraction CyberKnife-based stereotactic radiotherapy approach is safe and efficacious for the management for patients with SBP. Our findings suggest the potential use of this strategy as a definitive or salvage treatment option for SBP.

show abstract

Jugulotympanic paragangliomas: 75 years of evolution in understanding

Cited by 30 publications

References 57 publications

Initial experience with dual-lumen balloon catheter injection for preoperative Onyx embolization of skull base paragangliomas

Initial experience with dual-lumen balloon catheter injection for preoperative Onyx embolization of skull base paragangliomas

Zdravljenje jugularnih paragangliomov v UKC Maribor

A Retrospective Analysis of Tumor Volumetric Responses to Five-Fraction Stereotactic Radiotherapy for Paragangliomas of the Head and Neck (Glomus Tumors)

Contact Info

Product

Resources

About