Bilateral internal carotid aneurysms in the petrous temporal bones

A unique case of bilateral intrapetrous internal carotid aneurysms is reported. The importance of an accurate diagnosis before surgical intervention is stressed and the literature is reviewed.

Angioma of the jugular foramen. Case report

We describe a patient with a neoplasm closely mimicking a glumous jugulare tumour with regard to both clinical and radiological presentation. The tumour was removed by the transmastoid route. Only after histological examination of the excised neoplasm could the diagnosis of angioma be made. No other case of this nature has been found in the literature.

[Mucocutaneous angiomas in children. Must we still treat them?]

Muco-cutaneous angiomas are the most common vascular dysplasias in neonates born at term or especially prematurely. Rarely visible at birth, they appear during the first month of life, and always have a very great potential for development. Their extent is variable at onset, and their surface and volume, whatever their type, superficial, deep or mixed, both increase up to the age of 18 months and then diminish to be reabsorbed totally at the age of 3 to 4 years, leaving a zone of atrophic scarring with a cosmetic effect in proportion to the size of the lesion. The spontaneous cure of 90 % of these lesions is the argument used by clinicians who recommend therapeutic abstention. The conspicuous character of the scar, more marked in proportion to the size of the lesion, and the later involvement of organs subjacent to the angioma such as the eye, nasal cartilage, and bones, are the reasons which lead us instead to recommend the routine treatment of every tuberous angioma, provided certainly that such treatment is appropriate to the clinical variety ; treatment should be carried out as soon as possible after birth, and should not represent a risk disproportionate to the innocence of the lesion.

Immediate postembolization excision of glomus jugulare tumors: advantages of new combined techniques

Preoperative percutaneous transfemoral catheter embolization of feeding vessels in glomus jugulare tumors, followed by immediate application of standard surgical techniques, presents the treatment of choice, allowing meticulous microsurgery with virtually complete hemostasis. Therefore, the surgeon can operate in a bloodless environment throughout the compressed and intricate anatomic field, amidst such important yet vulnerable structures as cranial nerves, inner ear, carotid artery, jugular bulb, venous sinuses, and dura, while reducing surgical error and functional deficit for the patient. Review of the last 11 cases of glomus jugulare tumors at UCLA shows that even extensive Alford grade 2 tumors of the middle ear, jugular bulb, and mastoid had only minor blood losses with this combined technique of embolization-immediate surgery, as compared with earlier surgical methods. Pertinent literature on glomus jugulare and its treatment is reviewed. Combined embolization and immediate surgery offer the best approach for treatment of resectable glomus jugulare tumors.

Glomus jugulare tumors with intracranial extension

A glomus jugulare tumor with posterior fossa extension needs the expertise of the neuro-otologic surgeon and neurosurgeon to obtain total tumor removal. A one-stage combined otologic and neurosurgical procedure is presented for removal of base of skull tumors posterior to the carotid artery. Twelve cases of this type of tumor have been seen at The Cleveland Clinic. Two cases are presented in detail to illustrate the applicability of this procedure. In cases with infection around the temporal portion of the tumor, tumor extension around or anterior to the carotid artery, or extensive involvement of the posterior fossa, the procedure should be performed in two stages.

Panel discussion: glomus jugulare tumors of the temporal bone. The surgical management of glomus tumors

The authors describe the diagnosis and surgical management of 70 glomus tumors seen at the Otology Group in an 8 yr. period. The need for bilateral arteriograms to detect associated tumors (carotid body and intervagale) is stressed. A new surgical technique, the modified intratemporal fossa approach, is described for the removal of large glomus jugulare tumors involving the carotid artery. Complications and results are discussed in detail.

Schwannomas of the parapharyngeal space and jugular foramen

Schwannomas or neurilemmomas are among the most common neoplasms occupying the parapharyngeal space, yet only 107 cases have been previously reported. Neurilemmomas involving the jugular foramen are extremely rare. Only 55 cases have been reported in the world literature. The neoplasm occurred in the parapharyngeal space in three of our patients and in the jugular foramen in another patient. Of the tumors located in the parapharyngeal space, the nerve of origin in one of them was the glossopharyngeal, which is extremely rare. Adequate exposure for complete excision of parapharyngeal space tumors is best obtained through an external incision and should not be attempted transorally. In the jugular foramen case, the neoplasm arose from the vagus nerve high in the neck and extended intracranially in a "dumbbell" shape into the posterior cranial fossa. Total removal was successfully accomplished in one stage, by using a subtotal temporal bone resection--upper neck--posterior cranial fossa approach. Surgical removal is the treatment of choice. Schwannomas rarely recur following complete excision.

Impedance audiometry: its use in the diagnosis of glomus tympanicum tumors

Three cases of glomus tympanicum are presented. The audiological findings are discussed with special emphasis on the results of impedance audiometry. The use of impedance audiometry in the diagnosis and follow-up of glomus tympanicum tumors is suggested.

Tympanometry in the evaluation of vascular lesions of the middle ear and tinnitus of vascular origin

The occurrence of vascular perturbations in the tympanogram in association with glomus tumors has previously been noted in the literature. We have broadened the scope of this method of diagnosis in the study of 3 glomus tympanicum and 3 glomus jugulare tumors, 1 dehiscent high jugular bulb, 1 aberrant carotid artery in the middle ear and 2 cases of pulsatile tinnitus of vascular origin. Analysis of illustrative tympanograms at standard and at increased sensitivity (x 20) obtained in these cases are presented. The following factors as they relate to the mechanism of recording the vascular perturbations are presented: air pressure and/or presence of fluid in the middle ear; compliance of the tympanic membrane and ossicular chain as affected by the mass, size and degree of vascularity of the mass and presence of extraneous sounds. A new method of recording the vascular perturbations utilizing a time-base generator affixed to an X-Y plotter is described. It is the purpose of this study to demonstrate the utility of obtaining tympanograms at standard and at increased sensitivity in the evaluation of vascular middle ear lesions and tinnitus of vascular origin.

Glomus jugulare tumor presenting with increased intracranial pressure. Case report

✓ The authors report a case of glomus jugulare tumor presenting with papilledema and visual loss. The tumor was extremely vascular with significant shunting of arterial blood into venous sinuses. There was no intracranial extension of tumor, and papilledema resolved after removal of the lesion.

[The treatment of glomus jugulare tumours (author's transl)]

Symptoms and signs in 25 patients with glomus jugulare tumours are described. 14 patients with advanced tumours were treated exclusively by irradiation. No case of progression was noted during a follow-up period averaging 7.9 years.

The high position of the jugular bulb

The relationship between the bottom of the hypotympanon and the jugular bulb has been investigated on the basis of a histological analysis of 815 temporal bones. A high position of the jugular bulb has been found in 3.5% of the temporal bones examined. Only exceptionally does it occur bilaterally and is more often found on the right than left side. We distinguish two localizations of the high position of the bulb in the hypotympanon: the lateral and the medial. In either case the bulb may be damaged during myringotomy or during the removal of granulation tissue in middle ear surgery. Injury at myringotomy can be avoided only if there is a reinforcement of the bony wall. In the lateral position, the jugular bulb may be damaged when the tympanomeatal flap is being elevated. The bulb can occasionally be mistaken for a jugular glomus tumour. There is hardly any difference between cases where the bone between the bulb and the middle ear space is dehiscent or only very thin. The thickness of the bony shell is only 0.1-0.3 mm--thus there is no real protection against instrumental injuries.

Glomus tumor of the middle ear: origin, symptomatology, and treatment

The glomus tumor is considered to be the most common of all tumors that involve the middle ear. This report defines the glomus tumor and discusses the symptomatology of the tumor with respect to the various developmental courses it may follow. Forty clinical cases of glomus tumor are reviewed, with emphasis upon the incidence of the tumor and its symptoms, including the audiological manifestations noted in this series of cases. Current medical management of the glomus tumor recommends surgical removal of the lesion when possible; however, irradiation and embolization of the tumor may also be considered when its invasion into surrounding structures has been extensive. The pathology and its treatment may have marked temporary or permanent effects upon the hearing of the patient, and the importance of ongoing audiological management is therefore emphasized.

[Glomus tumors (author's transl)]

Pathology and clinical picture of glomus tumors are described with emphasis on their location on hand and digits. It is stressed that the knowledge of this rare but extremely painful condition is essential for early treatment. Surgical treatment is standardized and simple.

[Intracranial neurinoma of the spinal nerve (author's transl)]

A patient aged 56 years has developed a syndrome affecting the last cranial nerves--IX, X, XI and XII--on the left side progressively over the last two years, and, more recently, deafness. Apart from a simple radiological examination all other radiological tests were negative. The diagnosis was made during the surgical operation which revealed a neurinoma of nerve XI (spinal) in its intracranial path. The diagnosis was confirmed histologically. After reviewing the published literature, the authors conclude that this is an exceptional case, which justifies publication and enables differential diagnosis to be made between this tumor and the Jugular Glomus tumor.

Glomus jugulare tumour in a dog; a case report

Unilateral ataxia of the head and trunk and right-sided paralysis of the trigeminal, facial, and hypoglossal nerves were the major neurologic dysfunctions in a nine-year-old male French bulldog. These symptoms together with the results of radiologic examination and bone scintigraphy pointed to a cranial base tumour on the right side. The tumour was histologically identified as a glomus jugulare tumour. A tumour of the right carotid body and a seminoma in the right testicle were additional findings at autopsy.