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Park HH, Yoo J, Oh HC, Froelich S, Lee KS. The Anterolateral Approach, Revisited for Benign Jugular Foramen Tumors With Predominant Extracranial Extension: Microsurgical Anatomy and Case Series (SevEN-012). Oper Neurosurg (Hagerstown) 2023; 25:e135-e146. [PMID: 37195061 DOI: 10.1227/ons.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/19/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and lateral exposure than the extreme lateral and endoscopic endonasal approach, respectively. We describe the microsurgical anatomy of ALA with cadaveric specimens and report our clinical experience for benign JF tumors with predominant extracranial extension. METHODS A stepwise and detailed microsurgical neurovascular anatomy of ALA was explored with cadaveric specimens. Then, the clinical results of 7 consecutive patients who underwent ALA for benign JF tumors with predominant extracranial extension were analyzed. RESULTS A hockey stick skin incision is made along the superior nuchal line to the anterior edge of the sternocleidomastoid muscle (SCM). ALA involves layer-by-layer muscle dissection of SCM, splenius capitis, digastric, longissimus capitis, and superior oblique muscles. The accessory nerve runs beneath SCM and is found at the posterior edge of the digastric muscle. The internal jugular vein (IJV) is lateral to and at the level of the accessory nerve. The occipital artery passes over the longissimus capitis muscle and IJV and into the external carotid artery, which is lateral and superficial to IJV. The internal carotid artery (ICA) is more medial and deeper than external carotid artery and is in the carotid sheath with the vagus nerve and IJV. The hypoglossal and vagus nerves run along the lateral and medial side of ICA, respectively. Prehigh cervical carotid, prejugular, and retrojugular surgical corridors allow deep and extracranial access around JF. In the case series, gross and near-total resections were achieved in 6 (85.7%) patients without newly developed cranial nerve deficits. CONCLUSION ALA is a traditional and invaluable neurosurgical approach for benign JF tumors with predominant extracranial extension. The anatomic knowledge of ALA increases competency in adding anterior and lateral exposure of extracranial JF.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyeong-Cheol Oh
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Paris VII-Diderot University, Paris, France
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
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Li P, Tian Y, Song J, Yang Z, Zou X, Liu P, Zhu W, Chen L, Mao Y. Microsurgical intracranial hypervascular tumor resection immediately after endovascular embolization in a hybrid operative suite: A single-center experience. J Clin Neurosci 2021; 90:68-75. [PMID: 34275583 DOI: 10.1016/j.jocn.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was performed to investigate the safety and outcome of one-stage hybrid endovascular and microsurgical treatment of intracranial hypervascular tumors. METHODS The blood supply of the tumor was endovascularly embolized just before microsurgery in a one-stage fashion. Clinical data regarding the preoperative neurological status, tumor characteristics, hybrid treatment details and complications, intraoperative blood loss, and postoperative outcomes were collected prospectively and then analyzed. RESULTS Beginning in July 2016, 13 patients (5 women, 8 men) with intracranial hypervascular tumors were enrolled in this study, with a mean age of 48.2 ± 10.9 years. The patients' tumors comprised seven hemangioblastomas, three hemangiopericytomas, two meningiomas, and one mesenchymal chondrosarcoma. The mean maximum tumor diameter was 54.9 ± 21.5 mm. No major procedural complications occurred except catheterization-related bleeding in one patient. The mean percentage of tumor devascularization was 65.0%±17.5%. Gross total resection was achieved in 12 patients (92.3%). The mean blood loss volume during microsurgical resection was 703.8 ± 886.8 mL (range, 150-3600 mL). Symptoms improved in three patients and remained stable in six patients. CONCLUSIONS One-stage hybrid embolization before intracranial hypervascular tumor resection is a safe and effective procedure to decrease intraoperative blood loss. It can prevent or treat embolization-related complications in a timely manner and avoid the risk of multiple surgical procedures.
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Affiliation(s)
- Peiliang Li
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanlong Tian
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianping Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zixiao Yang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200032, China
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Rustemi O, Raneri F, Volpin L, Iannucci G. Complete embolization of jugular paragangliomas by direct puncture. Technical note. Br J Neurosurg 2018; 33:328-331. [DOI: 10.1080/02688697.2018.1527287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Oriela Rustemi
- Department of Neurosurgery, San Bortolo Hospital, Vicenza, Italy
| | - Fabio Raneri
- Department of Neurosurgery, San Bortolo Hospital, Vicenza, Italy
| | - Lorenzo Volpin
- Department of Neurosurgery, San Bortolo Hospital, Vicenza, Italy
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Liscak R, Urgosik D, Chytka T, Simonova G, Novotny J, Vymazal J, Guseynova K, Vladyka V. Leksell Gamma Knife radiosurgery of the jugulotympanic glomus tumor: long-term results. J Neurosurg 2015; 121 Suppl:198-202. [PMID: 25434953 DOI: 10.3171/2014.7.gks14923] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Glomus tumors usually display indolent behavior, and the effectiveness of radiation in stopping their growth can be assessed after long-term follow-up. Currently only midterm results of radiosurgery are available, so the authors included patients treated by Gamma Knife at least 10 years ago in this study to obtain a perspective of long-term results. METHODS During the period from 1992 to 2003, the Gamma Knife was used to treat 46 patients with glomus tumors. The age of the patients ranged from 21 to 79 years (median 56 years). Gamma Knife radiosurgery was the primary treatment in 17 patients (37%). Open surgery preceded radiosurgery in 46% of cases, embolization in 17%, and fractionated radiotherapy in 4%. The volume of the tumor ranged from 0.2 to 24.3 cm(3) (median 3.6 cm(3)). The minimal dose to the tumor margin ranged between 10 and 30 Gy (median 20 Gy). RESULTS One patient was lost for follow-up after radiosurgery. Clinical follow-up was available in 45 patients and 44 patients were followed with MRI in a follow-up period that ranged from 12 to 217 months (median 118 months). Neurological deficits improved in 19 (42%) of 45 patients and deteriorated in 2 patients (4%). Tumor size decreased in 34 (77%) of 44 patients with imaging follow-up, while an increase in volume was observed in 1 patient (2%) 182 months after radiosurgery and Gamma Knife treatment was repeated. One patient underwent another Gamma Knife treatment for secondary induced meningioma close to the glomus tumor 98 months after initial radiosurgical treatment. Seven patients died 22-96 months after radiosurgery (median 48 months), all for unrelated reasons. CONCLUSIONS Radiosurgery has proved to be a safe treatment with a low morbidity rate and a reliable long-term antiproliferative effect.
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Affiliation(s)
- Roman Liscak
- Departments of 1 Stereotactic and Radiation Neurosurgery
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Griauzde J, Srinivasan A. Imaging of Vascular Lesions of the Head and Neck. Radiol Clin North Am 2015; 53:197-213. [DOI: 10.1016/j.rcl.2014.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Makiese O, Chibbaro S, Marsella M, Tran Ba Huy P, George B. Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases. Neurosurg Rev 2011; 35:185-94; discussion 194. [PMID: 21947488 DOI: 10.1007/s10143-011-0346-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/24/2011] [Accepted: 05/24/2011] [Indexed: 11/24/2022]
Abstract
Jugular foramen paragangliomas are rare skull base tumours posing multiple complex diagnostic and management problems. We did a study to evaluate surgical technique, outcome and complications in 75 cases of tumours treated by multidisciplinary approach (i.e. combined neurosurgery, neuroradiology, ear, nose and throat surgery and intensive care unit team). Retrospective study on 75 consecutive patients with jugular foramen paragangliomas treated surgically from 1989 to 2005. Preoperative balloon occlusion test was performed in all patients as well as embolization (100%). A combined limited infratemporal and juxtacondylar approach was used in all patients. Gross total resection was achieved in 59 patients (78.7%). The most common complication was represented by lower cranial nerve deficits in five patients (6.6%), which was only temporary in three. Postoperative facial nerve weakness occurred in five cases (6.6%) and resolved in three of them. The remaining two patients underwent facial nerve reconstruction by hypoglossal/facial nerve anastomosis. Four patients (5.3%) had a postoperative cerebrospinal fluid leak, which was successfully treated by lumbar drainage. Two patients (2.7%) died because of complications related to surgical injury of lower cranial nerves: one patient developed aspiration pneumonia and septicemia and the second one developed a large cervico-bulbar hematoma that led to severe respiratory distress and ultimately global cerebral hypoxia. Paragangliomas are rare and complex skull base lesions that may be managed with low morbidity and mortality if a multidisciplinary approach is considered. Facial and lower cranial nerve postoperative deficits can be limited.
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Affiliation(s)
- Orphée Makiese
- Department of Neurosurgery, Lariboisiere Hospital Paris, Paris, France.
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Bruneau M, George B. The Juxtacondylar Approach to the Jugular Foramen. Oper Neurosurg (Hagerstown) 2008; 62:75-8; discussion 80-1. [DOI: 10.1227/01.neu.0000317375.38067.55] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
We sought to describe the juxtacondylar approach to jugular foramen tumors.
Methods:
Through an anterolateral approach, the third segment of the vertebral artery (between C2 and the dura mater) is controlled. The C1 transverse process of the atlas, which is located just inferiorly to the jugular foramen, is then removed. The dissection of the internal jugular vein is performed as high as possible, with control of the IXth, Xth, XIth, and XIIth cranial nerves. If required by a tumor extending into the neck, the internal and external carotid arteries can be exposed and controlled. Through a partial mastoidectomy and after removal of the bone covering the jugular tubercle, the end of the sigmoid sinus and then the posteroinferior part of the jugular foramen are reached.
RESULTS:
This technique is efficient to expose tumors extending into the jugular foramen. Contrary to the infratemporal approach, it has the main advantage of avoiding petrous bone drilling and associated potential complications. Lower cranial nerves are well exposed in the neck. In patients with schwannomas, complete resection with selective dividing of only the few involved rootlets can be achieved.
Conclusion:
The juxtacondylar approach is an efficient approach to tumors located in the jugular foramen. It necessitates control of the third segment of the vertebral artery but has the advantage of avoiding complications associated with petrous bone drilling. Extension beyond the jugular foramen requires combination with an infratemporal or a retrosigmoid approach.
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Affiliation(s)
- Michaël Bruneau
- Department of Neurosurgery, Hôpital Lariboisière, Paris, France
| | - Bernard George
- Department of Neurosurgery, Hôpital Lariboisière, Paris, France
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Yoshida K, Katayama M, Kuroshima Y, Akaji K, Onozuka S, Shiobara R, Kawase T. Glomus jugulare tumor presenting with intracerebellar hemorrhage. Skull Base Surg 2006; 10:101-5. [PMID: 17171110 PMCID: PMC1656757 DOI: 10.1055/s-2000-7275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
What is believed to be the first case of a glomus jugulare tumor presenting with intracerebellar hemorrhage is described. A 25-year-old normotensive man suddenly suffered from severe headache, nausea, vomiting, vertigo, and ataxia due to an intracerebellar hemorrhage. Magnetic resonance imaging and angiography revealed a highly vascular jugulare foramen tumor extending into the intracranial space adjacent to the hematoma. Total removal of the tumor was performed successfully via the combined pre- and retrosigmoid approach, and the histologic diagnosis was a glomus jugulare tumor. We concluded that one of the numerous draining veins on the surface of intracranial tumor, which were observed during the operation, was the origin of the intracerebellar hemorrhage.
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Bitaraf MA, Alikhani M, Tahsili-Fahadan P, Motiei-Langroudi R, Zahiri A, Allahverdi M, Salmanian S. Radiosurgery for glomus jugulare tumors: experience treating 16 patients in Iran. J Neurosurg 2006; 105 Suppl:168-74. [DOI: 10.3171/sup.2006.105.7.168] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectGlomus jugulare tumors (GJT) have traditionally been treated by surgery or fractionated external-beam radiotherapy. The aim of this retrospective study was to determine the tumor control rate, clinical outcome, and short-term complications of stereotactic radiosurgery in subsets of patients who are poor candidates for these procedures, based on age, medical problems, tumor size, or prior treatment failure.MethodsThe Leksell Gamma Knife was used to treat 16 patients harboring symptomatic, residual, recurrent, or unresectable GJTs. The age of the patients ranged from 12 to 77 years (median 46.5 years). Gamma Knife surgery (GKS) was performed as primary treatment in five patients (31.3%). Microsurgery preceded radiosurgery in 10 patients (62.5%) and fractionated radiotherapy in three patients (18.8%). The median tumor volume was 9.8 cm3 (range 1.7–20.6 cm3). The median marginal dose applied to a mean isodose volume of 50% (range 37–70%) was 18 Gy (range 14–20 Gy).Neurological follow-up examinations revealed improved clinical status in 10 patients (62.5%), a stable neurological status in six (37.5%), and no complications. After radiosurgery, follow-up imaging was conducted in 14 patients; the median interval from GKS to the last follow up was 18.5 months (range 4–28 months). Tumor size had decreased in six patients (42.9%), and the volume remained unchanged in the remaining eight (57.1%). None of the tumors increased in volume during the observation period.Conclusions According to the authors' experience, GKS represents a useful therapeutic option to control symptoms and may be safely conducted in patients with primary or recurrent GJTs with no death and no acute morbidity. Because of the tumor's naturally slow growth rate, however, long-term follow-up data are needed to establish a cure rate after radiosurgery.
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Deshmukh VR, Fiorella DJ, McDougall CG, Spetzler RF, Albuquerque FC. Preoperative embolization of central nervous system tumors. Neurosurg Clin N Am 2005; 16:411-32, xi. [PMID: 15694171 DOI: 10.1016/j.nec.2004.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vivek R Deshmukh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
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Mattos JP, Ramina R, Borges W, Ghizoni E, Fernandes YB, Paschoal JR, Honorato DC, Borges G. Intradural jugular foramen tumors. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:997-1003. [PMID: 15608958 DOI: 10.1590/s0004-282x2004000600012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and 2001. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.
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Affiliation(s)
- João Paulo Mattos
- Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil.
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Affiliation(s)
- Murat Cem Miman
- Department of Otolaryngology, Medical Faculty, Inonu University, Turgut Ozal Medical Center, 44300 Malatya, Turkey.
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Abstract
Jugulotympanic paragangliomas are the most common tumors of the middle ear and temporal bone. Although these larger tumors can prove to be formidable, the advent of microscopic and skull base surgical techniques has greatly enhanced the ability to treat and manage these tumors.
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Affiliation(s)
- P C Weber
- Department of Otolaryngology, The Cleveland Clinic, Cleveland, Ohio 44195, USA
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George B, Lot G, Tran Ba Huy P. The juxtacondylar approach to the jugular foramen (without petrous bone drilling). SURGICAL NEUROLOGY 1995; 44:279-84. [PMID: 8545782 DOI: 10.1016/0090-3019(95)00174-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical access to the jugular foramen is generally realized through the infratemporal approach, requires petrous bone drilling with facial nerve exposure and sometimes transposition. This is a rather complex and time-consuming technique that exposes the patient to complications such as deafness and facial nerve palsy. METHODS The juxtacondylar approach we propose in this paper needs only a partial mastoidectomy and exposure of the distal cervical segment of the vertebral artery (above C2). The transverse process of the atlas is completely removed so as to permit progress upward along the lateral mass of the atlas and the occipital condyle. The vertebral artery rarely has to be transposed. RESULTS The main indication for the juxtacondylar approach is neurinoma and meningioma of the jugular foramen. For tumors like paraganglioma extending into the petrous bone, the juxtacondylar approach can be combined with an infratemporal approach. The juxtacondylar approach has been used in seven cases including three neurinomas, three paragangliomas and one meningioma. Exposure was quite satisfactory on both intra- and extradural parts in all cases. CONCLUSIONS The juxtacondylar approach is a different way to expose the jugular foramen region. Compared to the standard infratemporal approach, it is a complementary rather than an alternative technique; the exposure is rather on the posteroinferior side for the juxtacondylar approach and on the anterosuperior side for the infratemporal approach.
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Affiliation(s)
- B George
- Service de Neurochirurgie, Hôpital Lariboisière, Paris, France
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Baguley DM, Irving RM, Hardy DG, Harada T, Moffat DA. Audiological findings in glomus tumours. BRITISH JOURNAL OF AUDIOLOGY 1994; 28:291-7. [PMID: 7757029 DOI: 10.3109/03005369409077313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Glomus tumours of the skull base are rare, but as they present with symptoms of hearing loss and tinnitus they are a clinical entity of which audiologists should be aware. This paper describes the findings of the major series of skull base glomus tumours found in the literature, and notes that the contribution of conductive and sensorineural components varies with tumour classification. The reported incidence of hearing loss and tinnitus in glomus tympanicum and glomus jugulare is reviewed and compared with the Cambridge series, in which two tumours were Fisch type A, four type B, two type C and five type D. In each case a mixed hearing loss was found, though the extent of sensorineural impairment was variable. The length of history of tumours limited to the middle-ear was far shorter (mean 8 months) than for more extensive lesions (type B, mean 64 months; C, 48 months; and D, 23 months). Eleven patients (85%) reported the symptom of hearing loss, and 12 (92.5%) of tinnitus, and some patients had experienced these symptoms for some time without seeking the advice of an otologist. It may be concluded that the presence of subjective pulsatile tinnitus or a retrotympanic mass should be considered an indication for an otological opinion, wherein the use of high resolution imaging techniques and arteriography will be considered in conjunction with detailed audiological assessment. Audiologists should be aware of the possibility of glomus tumour in such cases.
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Affiliation(s)
- D M Baguley
- Department of Audiology, Addenbrooke's Hospital, Cambridge, UK
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Watkins LD, Mendoza N, Cheesman AD, Symon L. Glomus jugulare tumours: a review of 61 cases. Acta Neurochir (Wien) 1994; 130:66-70. [PMID: 7725944 DOI: 10.1007/bf01405504] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A retrospective study of 61 patients with glomus jugulare tumours treated at the National Hospital for Neurology and Neurosurgery, and at the Royal National Throat, Nose and Ear Hospital, London. The average age at presentation was 41.7 years. The patients were mainly treated by a posterolateral combined otoneurosurgical approach. 42/61 of the patients had total or subtotal excision of their tumours, 7/61 had partial removal and the remaining 11/61 had no operation. Only one case required a 2-staged procedure. There were two deaths in the postoperative period, one from intracerebral haemorrhage and the other from the left hemisphere infarction. Postoperative radiotherapy was given to 5/7 of the patients who had partial removal. 3/40 of the patients with total removal had postoperative radiotherapy, and a further 3/40 had received radiotherapy pre-operatively. Of the 11 patients who did not undergo surgery, 7/11 were treated with radiotherapy and 4/11 had embolisation only.
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Affiliation(s)
- L D Watkins
- Gough-Cooper Department of Neurological Surgery, Institute of Neurology, London, U.K
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