Surgery of Glomus Jugulare Tumors

Abstract

The treatment of choice for glomus jugulare tumors is still controversial. High rates of morbidity, incomplete resection, and the aggressive behavior of these tumors are the main arguments for advocates of primary radiotherapy. However, constant refinements in skull base techniques have made complete resection of these lesions a realistic goal. The high probability of achieving local control of these tumors by surgery has convinced us to support this option strongly. Between 1993 and 2000 we diagnosed 52 glomus tumors of the temporal bone. Of these patients, only 42 had a class C lesion (glomus jugulare) and were included in this study; 37 of these patients underwent surgery, 10 of whom had intracranial extension of the disease. The overall resection rate was 96%. Facial nerve function at 1 year was House-Brackmann grade I to II in 52% of patients and grade III or better in 84% of patients. Hospitalization was shorter than 14 days in 33 patients (89%). All patients with pharyngolaryngeal palsy had sufficient compensation at discharge. Twelve vocal chord Teflon injections were performed after surgery to reduce hoarseness and aspiration. No patient died. No relapse was observed (mean follow-up, 4.9 years).

Vertebral Artery Involvement by Tympanojugular Paragangliomas: Management and Outcomes with a Proposed Addition to the Fisch Classification

“…As a consequence, the VA is often thought to be of significance only as a feeding vessel via the PICA. In the last 20 years, three cases of direct VA involvement by tumor [Patel et al, 1994;Gardner et al, 1997;Pareschi et al, 2003] have been reported, and this is further supported by the data from our 8 cases.…”

“…Inclusion criteria comprised cases describing VA involvement by TJP. There were 3 cases in the English literature that met our inclusion criteria [Patel et al, 1994;Gardner et al, 1997;Pareschi et al, 2003]. Including our 8 cases, a total of 11 cases are summarized in table 3 .…”

“…Gardner et al [1997] reported a case with involvement of Vie TJP, in which subtotal resection of the tumor was done followed by irradiation. Pareschi et al [2003] reported one case of VA involvement, but the exact treatment was not detailed. Patel at al.…”

“…In such a case, surgery without sufficient preoperative assessment of the artery may lead to incomplete tumor removal or vascular accidents. To the best of our knowledge, only three cases with tumor involving the VA have been reported in the English literature [Patel et al, 1994;Gardner et al, 1997;Pareschi et al, 2003].…”

The management of head-and-neck paragangliomas

“…Advanced or skull base-located tumours are associated with the highest rate of complications and functional disability (with a low response to rehabilitation measures in the elderly). In such tumours, surgery is less effective and more likely to inflict serious damage (Moe et al 1999, Pareschi et al 2003. However, many complications are not permanent or do not significantly affect long-term function significantly (Briner et al 1999).…”