The experience with the surgical treatment of glomus tumours
Abstract: It is concluded that the magnitude and extent of the surgical intervention and of the follow-up examination depend on the spread of the neoplasm. The treatment of the B, S, D - type tumours implies the necessity of pre-operative embolization of the vessels feeding the neoplasm.
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Algorithm of Surgical Treatment of Patients with Temporal Bone Paraganglioma Preserving Anatomical Organization and Sound-Conducting Apparatus of the Middle Ear
Цель. Улучшение функциональных результатов хирургического лечения пациентов с параганглиомой височной кости с помощью разработанного и введенного в практику отохирурга хирургического доступа. Материалы и методы. За период с февраля 2015 по февраль 2023 г. в ФГБУ НМИЦО обследовано и пролечено 203 пациента. Объем и методика операции определялись в зависимости от степени распространения новообразования, согласно классификации U. Fisch и D. Mattox в модификации М. Sanna от 2013 г., а также с учетом собственного опыта. Обследовано и прооперировано 203 пациента с параганглиомой височной кости: тип А – 34 пациента, из них с типом А1 – 10 пациентов, с типом А2 – 24 пациента; тип В – 89 пациентов, из них В1 – 25 пациентов, В2 – 27 пациентов, В3 – 37 пациентов; тип С – 80 пациентов, С1 – 34 пациента, тип С2 – 13 пациентов, тип С3 – 8 пациентов, тип С4 – 6 пациентов. Из них 34 мужчины и 96 женщин в возрасте от 28 до 82 лет. Результаты. Осуществлялась оценка результатов в ближайшем и отдаленном послеоперационном периоде у пациентов с проведенным разработанным хирургическим доступом. У всех пациентов после операции отмечалось улучшение слуха за счет увеличения порогов звукопроведения в среднем на 10–15 дБ. Всем пациентам с опухолью типа В3 за 24 ч до операции выполнялась селективная эмболизация сосуда, питающего опухоль. Интраоперационно у пациентов после эмболизации отмечалось уменьшение размера опухоли и снижение кровоточивости из опухоли, разница между объемом кровопотери с эмболизацией и без эмболизации составила 100–150 мл. Дисфункции лицевого нерва в раннем и отдаленном послеоперационном периоде не отмечалось. По данным лучевых исследований, через 6–12 месяцев рецидивов опухоли не отмечалось. Максимальный срок наблюдения составил 8 лет. Заключение. Предложенный алгоритм хирургического лечения пациентов с параганглиомой височной кости, основанный на данных лучевой диагностики на дооперационном этапе с использованием эндоваскулярной эмболизации, навигационной системы, микрохирургической техники и эндовидеоконтроля, при помощи разработанного хирургического доступа позволяет полностью удалить новообразование с сохранением жизненно важных структур среднего уха и латерального основания черепа. Purpose. To improve functional results of surgical treatment in patients with temporal bone paraganglioma using a surgical access elaborated and implemented in otosurgeon’s practice. Materials and methods. For the period from February 2015 to February 2023, a total of 203 patients were examined and treated in the Federal State Budgetary Institution National Medical Research Center for Otorhinolaryngology. Volume and technique of surgery were determined depending on the degree of incidence of the tumor in accordance with U. Fisch and D. Mattox the classification modified by М. Sanna in 2013, as well as taking into account own experience. 203 patients with temporal bone paraganglioma were examined and operated: A type – 34 patients, among them 10 patients with A1 type, 24 patients with A2 type; B type – 89 patients, among them 25 patients with B1 type, 27 patients with B2 type, 37 patients with B3 type; C type – 80 patients, 34 patients with C1 type, 13 patients with C2 type, 8 patients with C3 type, 6 patients with C4 type. Of them, 34 were men and 96 were women aged between 28 and 82. Results. Outcomes in the immediate and long-term postoperative period in patients underwent the elaborated surgical access were appraised. All patients noticed improvement of hearing after surgery due to the increase of sound conduction threshold averagely to 10–15 dB. Selective embolization of the vessel feeding the tumor was conducted to all patients with B3 type tumor 24 hours before the surgery. Intraoperatively, patients after embolization demonstrated decreased tumor size and reduced bleeding from the tumor; the difference between extent of blood loss with and without embolization amounted to 100–150 ml. Facial nerve weakness in the immediate and long-term post-operative period was not observed. According to the data of imaging studies tumor recurrence after 6–12 months was not observed. Maximum observation period was 8 years. Conclusion. Suggested algorithm of surgical treatment of patients with temporal bone paraganglioma, based on the data of X-ray diagnostics on the pre-operative stage using endovascular embolization, navigation system, microsurgical technique and endovideocontrol, with the help of the elaborated surgical access, allows a complete removal of the neoplasm while preserving the vital structures of the middle ear and the lateral base of the skull.
Algorithm of Surgical Treatment of Patients with Temporal Bone Paraganglioma Preserving Anatomical Organization and Sound-Conducting Apparatus of the Middle Ear
Цель. Улучшение функциональных результатов хирургического лечения пациентов с параганглиомой височной кости с помощью разработанного и введенного в практику отохирурга хирургического доступа. Материалы и методы. За период с февраля 2015 по февраль 2023 г. в ФГБУ НМИЦО обследовано и пролечено 203 пациента. Объем и методика операции определялись в зависимости от степени распространения новообразования, согласно классификации U. Fisch и D. Mattox в модификации М. Sanna от 2013 г., а также с учетом собственного опыта. Обследовано и прооперировано 203 пациента с параганглиомой височной кости: тип А – 34 пациента, из них с типом А1 – 10 пациентов, с типом А2 – 24 пациента; тип В – 89 пациентов, из них В1 – 25 пациентов, В2 – 27 пациентов, В3 – 37 пациентов; тип С – 80 пациентов, С1 – 34 пациента, тип С2 – 13 пациентов, тип С3 – 8 пациентов, тип С4 – 6 пациентов. Из них 34 мужчины и 96 женщин в возрасте от 28 до 82 лет. Результаты. Осуществлялась оценка результатов в ближайшем и отдаленном послеоперационном периоде у пациентов с проведенным разработанным хирургическим доступом. У всех пациентов после операции отмечалось улучшение слуха за счет увеличения порогов звукопроведения в среднем на 10–15 дБ. Всем пациентам с опухолью типа В3 за 24 ч до операции выполнялась селективная эмболизация сосуда, питающего опухоль. Интраоперационно у пациентов после эмболизации отмечалось уменьшение размера опухоли и снижение кровоточивости из опухоли, разница между объемом кровопотери с эмболизацией и без эмболизации составила 100–150 мл. Дисфункции лицевого нерва в раннем и отдаленном послеоперационном периоде не отмечалось. По данным лучевых исследований, через 6–12 месяцев рецидивов опухоли не отмечалось. Максимальный срок наблюдения составил 8 лет. Заключение. Предложенный алгоритм хирургического лечения пациентов с параганглиомой височной кости, основанный на данных лучевой диагностики на дооперационном этапе с использованием эндоваскулярной эмболизации, навигационной системы, микрохирургической техники и эндовидеоконтроля, при помощи разработанного хирургического доступа позволяет полностью удалить новообразование с сохранением жизненно важных структур среднего уха и латерального основания черепа. Purpose. To improve functional results of surgical treatment in patients with temporal bone paraganglioma using a surgical access elaborated and implemented in otosurgeon’s practice. Materials and methods. For the period from February 2015 to February 2023, a total of 203 patients were examined and treated in the Federal State Budgetary Institution National Medical Research Center for Otorhinolaryngology. Volume and technique of surgery were determined depending on the degree of incidence of the tumor in accordance with U. Fisch and D. Mattox the classification modified by М. Sanna in 2013, as well as taking into account own experience. 203 patients with temporal bone paraganglioma were examined and operated: A type – 34 patients, among them 10 patients with A1 type, 24 patients with A2 type; B type – 89 patients, among them 25 patients with B1 type, 27 patients with B2 type, 37 patients with B3 type; C type – 80 patients, 34 patients with C1 type, 13 patients with C2 type, 8 patients with C3 type, 6 patients with C4 type. Of them, 34 were men and 96 were women aged between 28 and 82. Results. Outcomes in the immediate and long-term postoperative period in patients underwent the elaborated surgical access were appraised. All patients noticed improvement of hearing after surgery due to the increase of sound conduction threshold averagely to 10–15 dB. Selective embolization of the vessel feeding the tumor was conducted to all patients with B3 type tumor 24 hours before the surgery. Intraoperatively, patients after embolization demonstrated decreased tumor size and reduced bleeding from the tumor; the difference between extent of blood loss with and without embolization amounted to 100–150 ml. Facial nerve weakness in the immediate and long-term post-operative period was not observed. According to the data of imaging studies tumor recurrence after 6–12 months was not observed. Maximum observation period was 8 years. Conclusion. Suggested algorithm of surgical treatment of patients with temporal bone paraganglioma, based on the data of X-ray diagnostics on the pre-operative stage using endovascular embolization, navigation system, microsurgical technique and endovideocontrol, with the help of the elaborated surgical access, allows a complete removal of the neoplasm while preserving the vital structures of the middle ear and the lateral base of the skull.
Glomus angioma: series of cases and literature review
Glomus tumors usually occur in areas rich in glomus bodies, such as the subungual areas of the fingers or the deep dermis of the palm, wrist, and forearm, but they can also occur in deep visceral sites throughout the body, including the lungs, stomach, pancreas, liver, gastrointestinal and urinary tracts. They are thought to have originated from modified smooth muscle cells of the neuromyoarterial glomus, commonly referred to as the glomus body, whose function is to regulate temperature through arteriovenous shunting of the blood. Important during the pathological process for these tumors are pain that persists for a long time, which is often necessary for their detection and the possibility of relapse.The purpose: to analyze and evaluate our own clinical cases of glomus angioma of various localization.Materials and methods. 6 patients with a morphologically verified diagnosis of glomus angioma (5 women and 1 man aged 23 to 50 years, mean age 34.5 years) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 2004 to 2023. All patients were operated on. Lesions localization: limbs soft tissues – 3, retroperitoneal space – 2, lung – 1.Results. The term of the lesions detection varied from 2 months to congenital. In 2 of 3 cases of the limbs soft tissues tumors localization they were congenital. Limbs soft tissues glomus tumors: the leions ranged in size from 40.0 × 28.65 mm to a large lesion, consisting of multiple foci ranging in size from 20.0 to 60.0 mm in diameter, all tumors were multinodular. Retroperitoneal glomus tumors: the lesions were rather large (a multinodular lesion from 6.0 to 48.0 mm in diameter and a single-nodular multi-chamber lesion of a polycyclic form, 150.0 × 100.0 × 80.0 mm in size). The lung glomus tumor was single-nodular and had a diameter of 12.5 mm. In the vast majority of cases (5/6), the lesions manifested with the pain and discomfort. Only the lung lesion was detected by chance and during a routine examination.The criteria for ultrasound and MSCT signs of the lesions of various localizations are given. The data are compared with literature data.Conclusion. Given the rarity of glomus angioma and the lack of publications on glomus angiomas of soft tissues of the extremities and deep-seated tumors in the domestic literature, the presented analysis of a series of our own cases will increase the awareness of clinicians and diagnosticians about these tumors and, thereby, increase their detection, which will allow for earlier surgery.
Glomus tumor is one of the most common temporal bone tumors. Most of them are benign and locally invasive, some are occasionally able to metastasize and have signs of malignancy. Diagnostic imaging is necessary before treatment. Computer tomography (CT) is traditionally used as a primary method of diagnosis, to recognize changes in the temporal bone. Role of magnetic resonance imaging (MRI) in temporal bone tumor diagnosis is not definitively determined.Purpose. To assess the possibilities of computer and magnetic resonance tomography, to develop an algorithm for the application of diagnostic imaging methods in the diagnosis of glomus tumors of the temporal bone.Material and methods. The article presents the experience of diagnosing 30 patients with glomus tumors.Results. The tympanic form of the glomus tumor was observed in 11 cases (37%), tympano-yugular in 19 cases (63%). CT and MRI data totally coincided in cases of small tumors (type A and B). In the presence of extended forms CT ability of assessing bone invasion, involvement of the internal carotid artery, internal jugular vein, and dural sinuses was lower than the MRI.
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