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Wu Y, Wei C, Wu Y, Zheng M, Yuan S, Xue Y, Qu Y, Zhao T. Surgical results, technical notes and complications of jugular foramen lesions via retroauricular infratemporal fossa approach. Clin Neurol Neurosurg 2024; 244:108445. [PMID: 39025019 DOI: 10.1016/j.clineuro.2024.108445] [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: 02/11/2024] [Revised: 07/06/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the clinical effect and safety of the postauricular infratemporal fossa approach (ITFA) in resecting jugular foramen lesions. METHODS All 25 patients undergoing microsurgery via postauricular ITFA from March 2015 to May 2023 in the Department of Neurosurgery, Tangdu Hospital, Air Force Military Medical University were included. The clinical and radiological data were retrospectively analyzed. Regular follow-up was carried out. RESULTS The mean age of all patients was 50.5±8.9 years, and 14 of them were female and 11 were male. Among the cases, lower cranial nerve schwannoma accounted for 60 % (15/25) of all tumors, jugular foramen paraganglioma accounted for 20 % (5/25), and the remaining 20 % included meningioma, chondrosarcoma, plasmacytoma, and salivary gland tumors. Total tumor resection was performed in 18 cases, subtotal tumor resection in 7 cases and partial resection in 1 case. Seven patients underwent gamma knife radiotherapy after surgery. Transient lower cranial nerve dysfunction occurred in 8 patients, and permanent lower cranial nerve dysfunction occurred in 2 patients after surgery. One patient developed facial paralysis, and one patient presented hearing loss. CONCLUSIONS The postauricular ITFA achieved a relatively high total tumor resection rate and a lower incidence of neurological functional disorders. It is an alternative and suitable surgical approach for resecting jugular foramen lesions. Maximizing the preservation of neurological function is preferred, especially when radical resection cannot be achieved. Stereotactic radiotherapy could be used for residual tumors.
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Affiliation(s)
- Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.
| | - Chen Wei
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.
| | - Yang Wu
- Department of Neurosurgery, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
| | - Min Zheng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.
| | - Shanqi Yuan
- Department of neurosurgery, Xi'an Ninth Hospital, Xi'an, China.
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.
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Darrat M, Lau L, Leonard C, Cooke S, Shahzad MA, McHenry C, McCance DR, Hunter SJ, Mullan K, Lindsay JR, Graham U, Bailie N, Hampton S, Rajendran S, Houghton F, Conkey D, Morrison PJ, Johnston PC. Clinical management and outcome of head and neck paragangliomas (HNPGLs): A single centre retrospective study. Clin Endocrinol (Oxf) 2024. [PMID: 38696538 DOI: 10.1111/cen.15070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/02/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
CONTEXT Head and neck paragangliomas (HNPGLs) are rare, usually benign, slow-growing tumours arising from neural crest-derived tissue. Definitive management pathways for HNPGLs have yet to be clearly defined. OBJECTIVE To review our experience of the clinical features and management of these tumours and to analyse outcomes of different treatment modalities. METHODS Demographic and clinical data were obtained from The Northern Ireland Electronic Care Record (NIECR) as well from a prospectively maintained HNPGL database between January 2011 through December 2023. RESULTS There were 87 patients; 50 females: 37 males with a mean age of 52.3 ± 14.2 years old (range 17-91 years old). 58.6% (n = 51) of patients had carotid body tumours, 25.2% (n = 22) glomus vagal tumours, 6.8% (n = 6) tumours in the middle ear, 2.2% (n = 2) in the parapharyngeal space and 1.1% (n = 1) in the sphenoid sinus. 5.7% (n = 5) of patients had multifocal disease. The mean tumour size at presentation was 3.2 ± 1.4 cm (range 0.5-6.9 cm). Pathogenic SDHD mutations were identified in 41.3% (n = 36), SDHB in 12.6% (n = 11), SDHC in 2.2% (n = 2) and SDHA in 1.1% (n = 1) of the patients. Overall treatment modalities included surgery alone in 51.7% (n = 45) of patients, radiotherapy in 14.9% (n = 13), observation in 28.7% (n = 25), and somatostatin analogue therapy with octreotide in 4.5% (n = 4) of patients. Factors associated with a significantly higher risk of recurrence included age over 60 years (p = .04), tumour size exceeding 2 cm (p = .03), positive SDHx variants (p = .01), and vagal and jugular tumours (p = .04). CONCLUSION The majority of our patients underwent initial surgical intervention and achieved disease stability. Our results suggest that carefully selected asymptomatic or medically unfit patients can be safely observed provided lifelong surveillance is maintained. We advocate for the establishment of a UK and Ireland national HNPGL registry, to delineate optimal management strategies for these rare tumours and improve long term outcomes.
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Affiliation(s)
- Milad Darrat
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Louis Lau
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Colin Leonard
- Department of Otolaryngology, Royal Victoria Hospital, Belfast, UK
| | - Stephen Cooke
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, UK
| | - Muhammad A Shahzad
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Claire McHenry
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Steven J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Karen Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - John R Lindsay
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Neil Bailie
- Department of Otolaryngology, Royal Victoria Hospital, Belfast, UK
| | - Susie Hampton
- Department of Otolaryngology, Royal Victoria Hospital, Belfast, UK
| | - Simon Rajendran
- Department of Pathology, Royal Victoria Hospital, Belfast, UK
| | | | - David Conkey
- Department of Oncology, Belfast City Hospital, Belfast, UK
| | | | - Philip C Johnston
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
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Yilala MH, Fancello G, Fancello V, Lauda L, Sanna M. Long-Term Surgical Outcome of Class A and B Tympanomastoid Paragangliomas. Cancers (Basel) 2024; 16:1466. [PMID: 38672548 PMCID: PMC11048109 DOI: 10.3390/cancers16081466] [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: 03/06/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients. STUDY DESIGN Retrospective study. METHOD The medical records of patients with surgically managed class A and B tympanomastoid PGLs between 1983 and 2023 were thoroughly evaluated. RESULT Our center has treated a total of 213 cases of tympanomastoid PGL surgically. The mean age of patients was 54, and the male-to-female ratio was 1:6. The most common symptoms at presentation were hearing loss (80%), pulsatile tinnitus (77%), and vertigo (15%). According to the modified Fisch classification, 45% of the cases were classified as class A (A1 and A2), while 55% were classified as class B (B1, B2, and B3). All class A and most class B1 and B2 tumors were removed either with transcanal or retroauricular-transcanal approaches. However, more advanced class B3 lesions were removed with subtotal petrosectomy (SP) along with middle ear obliteration. Facial nerve outcome was excellent in all class A and B cases, while chances of postoperative paresis slightly increased with the size and extent of the tumor (p < 0.05). The hearing outcome is excellent for class A1, A2, B1, and B2 tumors, whereas more advanced class B3 cases have a loss of air conduction (AC) and increased bone conduction (BC) threshold (p < 0.05). Complete surgical removal was achieved in 97% of our cases. The most common late complication was permanent TM perforation (7%), and the recurrence rate was 3%. CONCLUSIONS Tympanomastoid PGL represents the most common neoplasm of the middle ear space. The most frequent presenting symptoms include pulsatile tinnitus and hearing loss, whereas the presence of retrotympanic mass was evident in all cases at the time of initial otoscopic evaluation. Proper documentation of facial function and audiometric evaluation are crucial elements of preoperative workup. The most preferred preoperative radiologic examination is high-resolution computer tomography (HRCT), whereas magnetic resonance imaging (MRI) with or without gadolinium enhancement is reserved for cases with a dilemma of carotid artery or jugular bulb involvement. The main goal of tympanomastoid PGL treatment is complete disease removal with preservation of hearing and facial functions. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal, lower rate of recurrence and complication, and acceptable postoperative hearing level. Here, we present our 40 years of experience, which, to the very best of our knowledge, is the largest series of tympanomastoid PGL in the English literature.
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Affiliation(s)
- Melcol Hailu Yilala
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
- Department of Otorhinolaryngology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia
| | - Giuseppe Fancello
- Department of Otorhinolaryngology, Careggi University Hospital, 50134 Florence, Italy
| | - Virginia Fancello
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
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Mishael T, Philip B, George A, S S. Co-existing Paraganglioma, Cholesteatoma, and Otomastoiditis With Overlapping Imaging Features: A Diagnostic Challenge. Cureus 2023; 15:e42373. [PMID: 37621839 PMCID: PMC10445775 DOI: 10.7759/cureus.42373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Head and neck paragangliomas are rare neuroendocrine tumors arising from the autonomic nervous system. Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity on computed tomography; a salt-and-pepper appearance on standard spin-echo magnetic resonance imaging; and an intense blush on angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and predict operative morbidity and mortality. However, an atypical presentation of paragangliomas, especially when co-existing with other middle ear pathologies that have overlapping imaging findings, can often be misleading. Here, we report a case of simultaneous occurrence of paraganglioma, cholesteatoma, and otomastoiditis in a young adult female.
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Affiliation(s)
- Tom Mishael
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Babu Philip
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Arun George
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Sandeep S
- Radiology, St. John's Medical College Hospital, Bangalore, IND
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Campbell JC, Lee JW, Ledbetter L, Wick CC, Riska KM, Cunningham CD, Russomando AC, Truong T, Hong H, Kuchibhatla M, Kaylie DM. Systematic Review and Meta-analysis for Surgery Versus Stereotactic Radiosurgery for Jugular Paragangliomas. Otol Neurotol 2023; 44:195-200. [PMID: 36728610 DOI: 10.1097/mao.0000000000003781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Comprehensively analyze tumor control and treatment complications for jugular paraganglioma patients undergoing surgery versus stereotactic radiosurgery (SRS). DATABASES REVIEWED EMBASE, Medline, and Scopus. METHODS The databases were searched for English and Spanish articles from January 1, 1995, to January, 1, 2019, for studies reporting tumor control and treatment side effects regarding patients with jugular paraganglioma treated with surgery or SRS. Main outcome measures included short-term and long-term tumor recurrence, as well as postintervention complications. RESULTS We identified 10,952 original abstracts, 705 eligible studies, and 107 studies for final data extraction. There were 3,498 patients-2,215 surgical patients and 1,283 SRS patients. Bayesian meta-analysis was applied to the extracted data, with tau measurements for study heterogeneity. SRS tumors were larger (3.9 cm 3 versus 8.1 cm 3 ). Meta-analysis results demonstrated low rates of long-term recurrence for both modalities (surgery, 15%; SRS, 7%), with SRS demonstrating lower rates of postintervention cerebrospinal fluid leak, dysphagia, and cranial nerve Vll, lX, X, Xl, or Xll palsies. CONCLUSIONS This study demonstrates excellent control of jugular paragangiomas with both surgery and SRS, with higher rates of lower cranial neuropathies, dysphagia, and cerebrospinal fluid leaks among surgical patients.
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Affiliation(s)
- James C Campbell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine
| | - Jessica W Lee
- Departments of Radiation Oncology, Duke University Medical Center
| | - Leila Ledbetter
- Medical Center Library, Duke University, Durham, North Carolina
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri
| | | | - Calhoun D Cunningham
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine
| | - Alessandra C Russomando
- Department of Otolaryngology Head and Neck Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hwanhee Hong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - David M Kaylie
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine
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Dharnipragada R, Butterfield JT, Dhawan S, Adams ME, Venteicher AS. Modern Management of Complex Tympanojugular Paragangliomas: Systematic Review and Meta-Analysis. World Neurosurg 2023; 170:149-156.e3. [PMID: 36400356 DOI: 10.1016/j.wneu.2022.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Tympanojugular paragangliomas (TJPs) are slow-growing tumors arising within the middle ear or jugular foramen. The development of modified skull base approaches and the increasing use of stereotactic radiosurgery have provided more modern techniques in the management of TJPs. Several factors dictating approach selection, and resulting clinical outcomes have been inconsistently described. METHODS A systematic review of the literature describing modern management of complex TJPs was performed and summarized. A random-effects meta-analysis was performed to describe the rate of tumor control, complications, and symptom improvement in patients undergoing radiosurgery or surgical resection. RESULTS Nineteen studies were identified with a total of 852 TJP patients. A minority (153 patients) underwent radiosurgery while 699 underwent surgery. On meta-analysis, there was a 3.5% (95% confidence interval [CI]: 0.5%-6.4%) tumor growth rate following radiosurgery and 3.9% (95% confidence interval [CI]: 1.8%-6.0%) recurrence rate in surgical resection, with no significant moderator effect between the 2 groups (P = 0.9046). Complication rate for radiosurgery was 7.6% (95% CI: 2.8%-12.4%), differing significantly from surgical complication rates of 29.6% (95% CI: 17.1-42.0%, P = 0.0418). CONCLUSIONS Stereotactic radiosurgery and surgical resection for TJPs have similar rates of tumor recurrence. Radiation is associated with less risk and lower morbidity, yet there is comparably modest reduction of the tumor size. In sum, the data suggest that radiosurgery is a reasonable management option for patients with minimal symptoms who are high risk for surgery. Microsurgical resection should be reserved for patients with lower cranial neuropathies or those who have failed radiation treatment.
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Affiliation(s)
- Rajiv Dharnipragada
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - John T Butterfield
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Meredith E Adams
- Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA; Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew S Venteicher
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Bi WL, Santagata S. Skull Base Tumors: Neuropathology and Clinical Implications. Neurosurgery 2022; 90:243-261. [PMID: 34164689 DOI: 10.1093/neuros/nyab209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Tumors that arise in and around the skull base comprise a wide range of common and rare entities. Recent studies have advanced our understanding of their pathogenesis, which in some cases, have significantly influenced clinical practice. The genotype of meningiomas is strongly associated with their phenotype, including histologic subtype and tumor location, and clinical outcome. A single molecular alteration, NAB2-STAT6 fusion, has redefined the category of solitary fibrous tumors to include the previous entity hemangiopericytomas. Schwannomas, both sporadic and familial, are characterized by near ubiquitous alterations in NF2 , with additional mutations in SMARCB1 or LZTR1 in schwannomatosis. In pituitary adenohypophyseal tumors, cell lineage transcription factors such as SF-1, T-PIT, and PIT-1 are now essential for classification, providing a more rigorous taxonomy for tumors that were previously considered null cell adenomas. The pituicyte lineage transcription factor TTF-1 defines neurohypophyseal tumors, which may represent a single nosological entity with a spectrum of morphologic manifestations (ie, granular cell tumor, pituicytoma, and spindle cell oncocytoma). Likewise, the notochord cell lineage transcription factor brachyury defines chordoma, discriminating them from chondrosarcomas. The identification of nonoverlapping genetic drivers of adamantinomatous craniopharyngiomas and papillary craniopharyngiomas indicates that these are distinct tumor entities and has led to successful targeted treatment of papillary craniopharyngiomas using BRAF and/or mitogen-activated protein kinase inhibitors. Similarly, dramatic therapeutic responses have been achieved in patients with Langerhans cell histiocytosis, both with BRAF -mutant and BRAF -wildtype tumors. Familiarity with the pathology of skull base tumors, their natural history, and molecular features is essential for optimizing patient care.
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Affiliation(s)
- Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
- Laboratory of Systems Pharmacology, Harvard Medical School , Boston , Massachusetts , USA
- Ludwig Center at Harvard, Harvard Medical School , Boston , Massachusetts , USA
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de Souza SNF, Pongeluppi RI, Cardoso RAM, Abud DG, Colli BO, Massuda ET, de Oliveira RS. Glomus jugulare in a pediatric patient: case report and literature review. Childs Nerv Syst 2022; 38:269-277. [PMID: 34698910 DOI: 10.1007/s00381-021-05397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The jugular and tympanic glomus are rare neoplasms in the general population, being even more uncommon in the pediatric population. There is considerable morbidity associated with both disease and treatment. Treatment is essentially surgical, carried out in recent years in a multidisciplinary manner using preoperative embolization associated with microsurgery and eventually adjuvant radiotherapy. The outcome depends on the location of the lesion and its proximity to noble structures in addition to multidisciplinary monitoring in the postoperative period. METHODS In this article, a literature review was carried out in the PubMed database, finding reports from 17 patients diagnosed with the disease. Only articles in English were considered. RESULTS Moreover, we reported a case of a 14-year-old patient diagnosed with jugulotympanic glomus who underwent radical surgical treatment of the lesion. CONCLUSION This is a rare case of jugulotympanic glomus in a pediatric patient, who underwent surgical treatment associated with multidisciplinary therapy, with a favorable postoperative outcome.
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Affiliation(s)
- Stephanie Naomi Funo de Souza
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Rodrigo Inácio Pongeluppi
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Rodrigo Augusto Monteiro Cardoso
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Radiology, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Eduardo Tanaka Massuda
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
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Cleere EF, Martin‐Grace J, Gendre A, Sherlock M, O'Neill JP. Contemporary management of paragangliomas of the head and neck. Laryngoscope Investig Otolaryngol 2022; 7:93-107. [PMID: 35155787 PMCID: PMC8823187 DOI: 10.1002/lio2.706] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors typically arising from nonsecretory head and neck parasympathetic ganglia. Historically thought of as aggressive tumors that warranted equally aggressive surgical intervention, evidence has emerged demonstrating that the vast majority of HNPGLs are slow growing and indolent. It is also now recognized that a large proportion of HNPGLs are hereditary with succinate dehydrogenase gene mutations typically implicated. These recent advances have led to significant changes in the way in which clinicians investigate and treat HNPGLs with most now opting for more conservative treatment strategies. However, a proportion of patients present with more aggressive disease and still require nonconservative treatment strategies. Recent studies have sought to determine in which groups of patients the morbidity associated with treatment is justified. We summarize the recent advances in the understanding and management of these tumors and we provide our recommendations regarding the management of HNPGLs.
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Affiliation(s)
- Eoin F. Cleere
- Department of Otolaryngology‐Head and Neck surgeryBeaumont HospitalDublinIreland
- Royal College of Surgeons in IrelandDublinIreland
| | - Julie Martin‐Grace
- Royal College of Surgeons in IrelandDublinIreland
- Department of EndocrinologyBeaumont HospitalDublinIreland
| | - Adrien Gendre
- Department of Otolaryngology‐Head and Neck surgeryBeaumont HospitalDublinIreland
- Royal College of Surgeons in IrelandDublinIreland
| | - Mark Sherlock
- Royal College of Surgeons in IrelandDublinIreland
- Department of EndocrinologyBeaumont HospitalDublinIreland
| | - James P. O'Neill
- Department of Otolaryngology‐Head and Neck surgeryBeaumont HospitalDublinIreland
- Royal College of Surgeons in IrelandDublinIreland
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Kaul VF, Filip P, Schwam ZG, Wanna GB. Nuances in transcanal endoscopic surgical technique for glomus tympanicum tumors. Am J Otolaryngol 2020; 41:102562. [PMID: 32563784 DOI: 10.1016/j.amjoto.2020.102562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/24/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the utility and nuances of transcanal endoscopic surgery (TCES) on glomus tympanicum tumors from a single surgeon's experience. PATIENTS/INTERVENTION Twelve patients, eight female and four males, diagnosed pre-operatively with glomus tympanicum tumors. They all underwent endoscopic resection by a single surgeon. MAIN OUTCOME MEASURES Feasibility of endoscopic resection of glomus tympanicum tumors without conversion to a microscopic approach. Secondary outcomes include tumor stage, pre and post-operative audiometry, vertigo, sensorineural hearing loss (SNHL) and integrity of the facial nerve, ossicles, chorda tympani and tympanic membrane. RESULTS Twelve patients underwent TCES, eight patient's pathology results were glomus tympanicum, ranging from Glasscock-Jackson grade I-III. Due to loss in follow up, 6/8 patients had complete audiometric data, which were analyzed. Average pre-operative air-bone-gap (ABG) was 5.41 compared to post-operative ABG of 5.08 (p > 0.89). No patients resulted in any, post-operative vertigo, tinnitus, SNHL, facial nerve injury or chorda tympani nerve injury. Two patients had intentional tympanic membrane perforations secondary to tumor adherence to the membrane. They were repaired with tragal perichondrium graft. No patients have had any recurrences. CONCLUSIONS Endoscopic resection of glomus tympanicum tumors is a feasible and effective, alternative visualization modality for the neurotologist. Surgical pearls are described herein.
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Affiliation(s)
- Vivian F Kaul
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Peter Filip
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Cass ND, Schopper MA, Lubin JA, Fishbein L, Gubbels SP. The Changing Paradigm of Head and Neck Paragangliomas: What Every Otolaryngologist Needs to Know. Ann Otol Rhinol Laryngol 2020; 129:1135-1143. [PMID: 32486832 DOI: 10.1177/0003489420931540] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recommendations regarding head and neck paragangliomas (HNPGL) have undergone a fundamental reorientation in the last decade as a result of increased understanding of the genetic and pathophysiologic basis of these disorders. OBJECTIVE We aim to provide an overview of HNPGL and recent discoveries regarding their molecular genetics, along with updated recommendations on workup, treatment, and surveillance, and their implications for otolaryngologists treating patients with these disorders. RESULTS SDHx susceptibility gene mutations, encoding subunits of the enzyme succinate dehydrogenase (SDH), give rise to the Hereditary Pheochromocytoma/Paraganglioma Syndromes. SDHA, SDHB, SDHC, SDHD, and SDHAF2 mutations each result in unique phenotypes with distinct penetrance and risk for variable tumor development as well as metastasis. Genetic and biochemical testing is recommended for every patient with HNPGL. Multifocal disease should be managed in multi-disciplinary fashion. Patients with SDHx mutations require frequent biochemical screening and whole-body imaging, as well as lifelong follow-up with an expert in hereditary pheochromocytoma and paraganglioma syndromes. CONCLUSION Otolaryngologists are likely to encounter patients with HNPGL. Keeping abreast of the latest recommendations, especially regarding genetic testing, workup for additional tumors, multi-disciplinary approach to care, and need for lifelong surveillance, will help otolaryngologists appropriately care for these patients.
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Affiliation(s)
- Nathan D Cass
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa A Schopper
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Lauren Fishbein
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samuel P Gubbels
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
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吴 媛, 黄 德, 冯 勃. [Analysis of misdiagnosis glomus jugulare tumor]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:432-435. [PMID: 32791614 PMCID: PMC10133169 DOI: 10.13201/j.issn.2096-7993.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Indexed: 06/11/2023]
Abstract
Objective:To analyze the causes of misdiagnosis of patients with glomus jugulare tumor. Method:The clinical data of 116 patients with glomus jugulare tumor were retrospectively analyzed. Result:Among the 116 patients, 65 were misdiagnosed, the average duration of misdiagnosis was 4.90 years. The misdiagnosed diseases were chronic otitis media or cholesteatoma in 25 cases, neurological tinnitus or hearing loss in 16 cases, facial paralysis in 6 cases, external auditory canal masses in 4 cases, secretory otitis media in 3 cases, neck mass in 3 cases, intracranial neoplasma in 2 cases, middle ear cancer in 1 case, vocal cord paralysis in 1 case, stomatitis in 1 case, optic nerve head edema in 1 case, middle ear hemangioma in 1 case and vascular tinnitus in 1 case. Conclusion:The misdiagnosis of glomus jugulare tumor can be summarized as follows: the patients' first symptoms were not specific; lack of auxiliary examination, especially imaging examination; physicians have insufficient understanding of imaging and pathological examination of glomus jugulare tumor.
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Affiliation(s)
- 媛媛 吴
- 湖北医药学院附属襄阳市第一人民医院耳鼻咽喉科(湖北襄阳,441000)Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
| | - 德亮 黄
- 中国人民解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室 解放军总医院医疗大数据应用技术国家工程实验室College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital; National Clinical Research Center for Otolaryngologic Diseases; State Key Lab of Hearing Science, Ministry of Education of China; Beijing Key Lab of Hearing Impairment Prevention and Treatmen; National Engineering Laboratory for Medical Big Data Application Technology
| | - 勃 冯
- 中国人民解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室 解放军总医院医疗大数据应用技术国家工程实验室College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital; National Clinical Research Center for Otolaryngologic Diseases; State Key Lab of Hearing Science, Ministry of Education of China; Beijing Key Lab of Hearing Impairment Prevention and Treatmen; National Engineering Laboratory for Medical Big Data Application Technology
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13
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Fatima N, Pollom E, Soltys S, Chang SD, Meola A. Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:741-752. [PMID: 32318920 DOI: 10.1007/s10143-020-01292-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Head and neck paragangliomas (HNPs) are rare, usually benign hyper vascularized neuroendocrine tumors that traditionally have been treated by surgery, with or without endovascular embolization, or, more recently stereotactic radiosurgery (SRS). The aim of our study is to determine the clinical and radiographic effectiveness of SRS for treatment of HNPs. A systematic search of electronic databases was performed, and 37 articles reporting 11,174 patients (1144 tumors) with glomus jugulare (GJT: 993, 86.9%), glomus tympanicum (GTT: 94, 8.2%), carotid body tumors (CBTs: 28, 2.4%), and glomus vagale (GVT: 16, 1.4%) treated with SRS definitively or adjuvantly were included. The local control (LC) was estimated from the pooled analysis of the series, and its association with SRS technique as well as demographic and clinical factors was analyzed. The median age was 56 years (44-69 years). With a median clinical and radiological follow-up of 44 months (9-161 months), LC was 94.2%. Majority of the patients (61.0%) underwent Gamma Knife Radiosurgery (GKS), but there was no statistically significant difference in LC depending upon the SRS technique (p = 0.9). Spearmen's correlation showed that LC was strongly and negatively correlated with multiple parameters, which included female gender (r = - 0.4, p = 0.001), right-sided tumor (r = - 0.3, p = 0.03), primary SRS (r = - 0.5, p ≤ 0.001), and initial clinical presentation of hearing loss (r = - 0.4, p = 0.001). To achieve a LC ≥ 90%, a median marginal dose (Gy) of 15 (range, 12-30 Gy) was required. The results corroborate that SRS in HNPs is associated with good clinical and radiological outcome.
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Affiliation(s)
- Nida Fatima
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA.
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, USA
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14
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Abstract
Since Felix Fränkel's account of pheochromocytoma in 1886, great discoveries and vast advancements in the diagnosis, genetics, anatomical and functional imaging techniques, and surgical management of pheochromcytoma and paraganglioma (P-PGL) have been made. The improved insight in the pathophysiology of P-PGL and more accurate detection methods enable physicians to tailor the treatment plan to an individual based on the genetic profile and tumor behavior. This review will cover briefly the clinical features, diagnosis, genetic mutations, and imaging modalities that are used to guide current surgical management of these rare and interesting endocrinopathies.
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Affiliation(s)
- Douglas Wiseman
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mustapha El Lakis
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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15
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Large Intradural Tympanojugular Paragangliomas. A Contribution on Surgery and Management. World Neurosurg 2019; 122:e1482-e1490. [DOI: 10.1016/j.wneu.2018.11.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/20/2022]
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Isaacson B, Wick CC, Perez C, Cantrell SC, Killeen DE. Pathophysiology of sensorineural hearing loss in jugular foramen paraganglioma. Laryngoscope 2018; 129:67-75. [PMID: 30194736 DOI: 10.1002/lary.27343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/18/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Pathologic involvement of the inferior cochlear vein is a mechanism of sensorineural hearing loss in patients with jugular foramen paraganglioma. STUDY DESIGN Retrospective case-control study. METHODS The presenting audiograms, magnetic resonance imaging, and computed tomography were reviewed in 46 subjects with jugular foramen paragangliomas. Four-frequency bone conduction average was compared between the tumor and nontumor ears in each subject to establish the presence of sensorineural hearing loss. Imaging findings for each subject were recorded. Univariate and multivariate statistical analyses were performed to determine which radiographic features were associated with sensorineural hearing loss. Hearing data were analyzed as a continuous variable and as a categorical variable. RESULTS Twenty subjects (43.4%) had a bone-conduction pure-tone asymmetry of greater than 15 dB. Inferior cochlear vein involvement was identified in 19 of the 20 (95%) subjects with sensorineural hearing loss. Inferior cochlear vein involvement was found to be a statistically significant predictor of sensorineural hearing loss using univariate and multivariate analyses. Other imaging findings that were statistically significant predictors of sensorineural hearing loss include Glasscock-Jackson stage, Fisch-Mattox stage, hypoglossal canal involvement, jugulo-carotid spin erosion, and petrous carotid canal erosion. CONCLUSIONS Involvement of the inferior cochlear vein appears to be a plausible mechanism for sensorineural hearing loss in patients with jugular foramen paraganglioma. LEVEL OF EVIDENCE 4 Laryngoscope, 129:67-75, 2019.
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Affiliation(s)
- Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Carlos Perez
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Sarah C Cantrell
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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17
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Active surveillance management of head and neck paragangliomas: case series and review of the literature. The Journal of Laryngology & Otology 2017; 131:580-584. [DOI: 10.1017/s0022215117000809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Head and neck paragangliomas are rare. They are usually slow-growing, benign, non-catecholamine secreting tumours, traditionally treated with surgical excision. Complications of surgical excision include lower cranial nerve palsies, stroke and death.Method:A retrospective case note analysis was conducted of patients with head and neck paragangliomas treated with a watch-and-scan policy from March 2003 to September 2015, and the relevant literature was reviewed.Results:Fifteen head and neck paragangliomas were identified. None of the patients developed a new lower cranial nerve palsy or progression of their presenting hearing loss during the follow-up period. Five patients displayed an increase in maximum linear dimension of 4 mm over an average of 57.4 months. A review of the literature showed that a watch-and-surveillance scan policy is evolving as a treatment option for head and neck paragangliomas without malignant risk factors.Conclusion:Readily available surveillance scanning in head and neck paragangliomas enables the monitoring of head and neck paragangliomas, which may allow for avoidance of major surgery.
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18
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Chaaya G, Morales J, Castiglioni A, Subhani N, Asmar A. Paraganglioma of the Urinary Bladder: A Rare Cause of Hypertension and Urinary Tract Infections. Am J Med Sci 2017; 355:191-194. [PMID: 29406048 DOI: 10.1016/j.amjms.2017.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/28/2017] [Accepted: 03/21/2017] [Indexed: 02/07/2023]
Abstract
Pheochromocytoma is a neoplasm, which develops from cells of the chromaffin tissues that are derived from the ectodermic neural system and mostly situated within the adrenal medulla. Approximately 15% of pheochromocytoma cases arise from extra-adrenal chromaffin tissue. Pheochromocytoma of the bladder is rare and accounts for less than 0.06% of all bladder neoplasms and less than 1% of all pheochromocytomas. We report a case of a young woman who presented with uncontrolled hypertension, recurrent urinary tract infections and micturition attacks and was found to have a metastatic bladder paraganglioma. In addition, we provide a summary table of the clinical manifestations of paragangliomas based on anatomic locations.
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Affiliation(s)
- Gerard Chaaya
- University of Central Florida College of Medicine, Orlando, Florida
| | - Jorge Morales
- University of Central Florida College of Medicine, Orlando, Florida
| | - Analia Castiglioni
- University of Central Florida College of Medicine, Orlando, Florida; Orlando VA Medical Center, Orlando, Florida
| | - Noman Subhani
- University of Central Florida College of Medicine, Orlando, Florida; Osceola Regional Medical Center, Kissimmee, Florida
| | - Abdo Asmar
- University of Central Florida College of Medicine, Orlando, Florida; Orlando VA Medical Center, Orlando, Florida.
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19
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Abstract
The posterior skull base can be involved by a variety of pathologic processes. They can be broadly classified as: traumatic, neoplastic, vascular, and inflammatory. Pathology in the posterior skull base usually involves the lower cranial nerves, either as a source of pathology or a secondary source of symptoms. This review will categorize pathology arising in the posterior skull base and describe how it affects the skull base itself and surrounding structures.
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Affiliation(s)
- Joici Job
- Department of Radiology, University of Pittsburgh Medical Center, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Barton F Branstetter
- Department of Radiology, University of Pittsburgh Medical Center, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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20
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Treatment of glomus tympanicum tumors by preoperative embolization and total surgical resection. Am J Otolaryngol 2016; 37:544-551. [PMID: 27650391 DOI: 10.1016/j.amjoto.2016.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/29/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness on function preservation and tumor control of the treatment of glomus tympanicum tumors with pre-operative embolization followed by total surgical resection. MATERIAL AND METHODS We describe a series of 6 patients with a glomus tympanicum tumor who were treated in our hospital using the same technique: the day before surgery selective tumor embolization due to denaturation with 96% ethanol. Following parameters were considered: tumor classification, tumor control, clinical and audiological outcome, effectiveness of embolization, percentage of tumor necrosis and treatment complications. RESULTS There were no severe complications due to embolization or surgery. Tumor blush disappeared completely in 5 patients on DSA post embolization and histologic evaluation of the resected tissue showed a median of 69.2% of tumor necrosis. Pulsatile tinnitus disappeared in all patients and 3 patients had no symptoms at all. Hearing ameliorated in 4 patients, 1 patient without hearing loss pre- treatment still had normal hearing after treatment and 1 patient's hearing was worse after treatment. Average follow-up was 21.3months. CONCLUSIONS Treatment of glomus tympanicum tumors by pre-operative embolization with ethanol and surgical resection has not been described before. Our results show that it is a safe procedure with a good long term tumor control, good clinical and audiological outcome.
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Schuster D, Sweeney AD, Stavas MJ, Tawfik KY, Attia A, Cmelak AJ, Wanna GB. Initial radiographic tumor control is similar following single or multi-fractionated stereotactic radiosurgery for jugular paragangliomas. Am J Otolaryngol 2016; 37:255-8. [PMID: 27178519 DOI: 10.1016/j.amjoto.2016.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/11/2016] [Accepted: 01/16/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate radiographic tumor control and treatment-related toxicity in glomus jugulare tumors treated with stereotactic radiosurgery (SRS). STUDY DESIGN Retrospective chart review. SETTING Tertiary academic referral center. PATIENTS Glomus jugulare tumors treated with SRS between 1998 and 2014 were identified. The data analysis only included patients with at least 18months of post-treatment follow up (FU). INTERVENTION Patients were treated with either single fraction or fractionated SRS. MAIN OUTCOME MEASURE Patient demographics and tumor characteristics were assessed. Radiographic control was determined by comparing pre and post treatment MRI, and was categorized as no change, regression, or progression. RESULTS Eighteen patients were treated with SRS, and 14 met inclusion criteria. Median age at treatment was 55years (range 35-79), and 71.4% of patients were female. 5 patients (35.7%) received single fraction SRS (dose range 15-18Gy), and 9 (64.3%) fractionated therapy (dose 3-7Gy×3-15 fractions). Median tumor volume was 3.78cm(3) (range 1.15-30.6). Median FU was 28.8months (range 18.6-56.1), with a mean of 31.7months. At their last recorded MRI, 7 patients (50%) had tumor stability, 6 (42.9%) had improvement, and 1 (7.1%) had progression. Disease improvement and progression rates in the single fraction group were 40% and 0%, and in the multiple-fraction group, 44.4% and 11.1%, respectively. There was no statistically significant difference in disease improvement (p=0.88) or progression (p=0.48) rates between groups (unpaired t-test). CONCLUSIONS At a median follow up of 28months, both single fraction and fractionated SRS appear to have comparable radiographic tumor control outcomes and toxicity profiles.
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22
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Li D, Zeng XJ, Hao SY, Wang L, Tang J, Xiao XR, Meng GL, Jia GJ, Zhang LW, Wu Z, Zhang JT. Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective. J Neurosurg 2016; 125:1143-1154. [PMID: 26918473 DOI: 10.3171/2015.10.jns151875] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the neurological functional outcome and recurrent risks in surgically treated jugular foramen paragangliomas (JFPs) and to propose an individualized therapeutic strategy. METHODS Clinical charts and radiological information were reviewed retrospectively in 51 consecutive cases of JFPs. Less-aggressive surgical interventions were adopted with the goal of preserving neurovascular structures. Scheduled follow-up was performed. RESULTS The mean age of the patients in the cases reviewed was 41.6 years, and the group included 27 females (52.9%). The mean preoperative Karnofsky Performance Scale (KPS) score was 78.4. The mean lesion size was 3.8 cm. Forty-three cases (84.3%) were Fisch Type D, including 37 cases (72.5%) of Type Di1 and Di2. Thirty-seven cases (72.5%) were Glasscock-Jackson Type III-IV. Gross-total resection and subtotal resection were achieved in 26 (51.0%) and 22 (43.1%) cases, respectively. Surgical morbidities occurred in 23 patients (45.1%), without surgery-related mortality after the first operation. The mean postoperative KPS scores at discharge, 3 months, 1 year, and most recent evaluation were 71.8, 77.2, 83.2, and 79.6, respectively. The mean follow-up duration was 85.7 months. The tumor recurrence/regrowth (R/R) rate was 11.8%. Compared with preoperative status, swallowing function improved or stabilized in 96.1% and facial function improved or stabilized in 94.1% of patients. A House-Brackmann scale Grade I/II was achieved in 43 patients (84.3%). Overall neurological status improved or stabilized in 90.0% of patients. Pathological mitosis (HR 10.640, p = 0.009) was the most significant risk for tumor R/R. A 1-year increase in age (OR 1.115, p = 0.037) and preoperative KPS score < 80 (OR 11.071, p = 0.018) indicated a risk for recent poor neurological function (KPS < 80). Overall R/R-free survival, symptom progression-free survival, and overall survival at 15 years were 78.9%, 86.8%, and 80.6%, respectively. CONCLUSIONS Surgical outcomes for JFPs were acceptable using a less-aggressive surgical strategy. Most patients could adapt to surgical morbidities and carry out normal life activities. Preserving neurological function was a priority, and maximal decompression with or without radiotherapy was desirable to preserve a patient's quality of life when radical resection was not warranted. Early surgery plus preoperative devascularization was proposed, and radiotherapy was mandatory for lesions with pathological mitosis.
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Affiliation(s)
- Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Xiao-Jun Zeng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Shu-Yu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Jie Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Xin-Ru Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Guo-Lu Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Gui-Jun Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.,China National Clinical Research Center for Neurological Diseases.,Center of Brain Tumor, Beijing Institute for Brain Disorders; and.,Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
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24
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Hoyne DS, Mowry SE, Hansen MR. Canal wall reconstruction and conductive hearing preservation for temporal bone paraganglioma. Laryngoscope 2015; 126:988-91. [PMID: 26226926 DOI: 10.1002/lary.25514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/18/2015] [Accepted: 06/24/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Danielle S Hoyne
- Departments of Otolaryngology-Head and Neck Surgery, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Sarah E Mowry
- Departments of Otolaryngology-Head and Neck Surgery, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, U.S.A
| | - Marlan R Hansen
- Departments of Otolaryngology-Head and Neck Surgery, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.,Department of Neurosurgery, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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25
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Abstract
Paragangliomas that arise from the jugular bulb are known to present as masses in the neck or with hearing loss, pulsatile tinnitus, and lower cranial nerve palsies. Much less recognized is their tendency to cause increased intracranial pressure and papilledema by obstructing jugular venous outflow. Only 7 such cases have been reported and with minimal ophthalmic documentation. We describe 3 more cases to provide additional documentation and to emphasize that paragangliomas are a potential cause of the pseudotumor cerebri syndrome, and that papilledema may be overlooked when a jugular paraganglioma is diagnosed or after it has been treated. Such lapses have led to disabling vision loss from damage to the optic nerves in long-standing papilledema.
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26
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Abstract
CONCLUSION Lesions involving the jugular foramen (JF) present as various diagnoses. Pulsatile tinnitus is more common in glomus jugulare (GJ) tumors, whereas otalgia and facial nerve paresis are more prevalent in temporal bone malignancies (TBMs). Preoperative facial nerve electroneurography (ENoG) was significantly correlated with postoperative facial nerve function. OBJECTIVE To describe the diagnosis and surgical management of lesions involving the JF. METHODS The charts were reviewed for 38 patients who had lesions involving the JF, including 14 patients with TBMs, 11 with GJ tumors, 7 with cholesteatomas, 2 with facial nerve schwannomas, 2 with JF schwannomas, and 2 with cholesterol granulomas. The follow-up data were recorded. RESULTS The most frequent symptoms included hearing loss (89.47%), followed by otorrhea (47.37%) and pulsatile tinnitus (39.47%). With respect to TBMs, 57.14% of patients complained of otorrhea and otalgia, and 50.00% presented with facial nerve paresis. Among the 13 patients with facial nerve paresis, 53.85% were diagnosed with TBMs. Regarding GJ tumors, 81.82% had pulsatile tinnitus and hearing loss. Among the 25 patients with normal preoperative facial nerve function, the mean facial nerve ENoG reduction was 29.48 ± 29.15%, and the mean postoperative facial nerve score was 77.48 ± 33.13. The correlation coefficient was -0.973 (p = 0.000).
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Affiliation(s)
- Wei Li
- Otology & Skull Base Surgery Department
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27
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Michelozzi C, Januel AC, Cuvinciuc V, Tall P, Bonneville F, Fraysse B, Deguine O, Serrano E, Cognard C. Arterial embolization with Onyx of head and neck paragangliomas. J Neurointerv Surg 2015; 8:626-35. [PMID: 25935924 DOI: 10.1136/neurintsurg-2014-011582] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/27/2015] [Indexed: 11/04/2022]
Abstract
OBJECT To report the morbidity and long term results in the treatment of paragangliomas by transarterial embolization with ethylene vinyl alcohol (Onyx), either as preoperative or palliative treatment. METHODS Between September 2005 and 2012, 18 jugulotympanic, 7 vagal, and 4 carotid body paragangliomas (CBPs) underwent Onyx embolization, accordingly to our head and neck multidisciplinary team's decision. CBPs were embolized preoperatively. Jugulotympanic and vagal paragangliomas underwent surgery when feasible, otherwise palliative embolization was carried out alone, or in combination with radiotherapy or tympanic surgery in the case of skull base or tympanic extension. Treatment results, and clinical and MRI follow-up data were recorded. RESULTS In all cases, devascularization of at least 60% of the initial tumor blush was obtained; 6 patients underwent two embolizations. Post-embolization, 8 patients presented with cranial nerve palsy, with partial or complete regression at follow-up (mean 31 months, range 3-86 months), except for 2 vagal and 1 hypoglossal palsy. 10 patients were embolized preoperatively; 70% were cured after surgery and 30% showed residual tumor. 19 patients received palliative embolization, of whom 5 underwent radiotherapy and 3 received tympanic surgery post-embolization. Long term follow-up of palliative embolization resulted in tumor volume stability (75%) or extension in intracranial or tympanic compartments. Onyx embolization of CBPs resulted in more difficult surgical dissection in 2 of 4 cases. CONCLUSIONS Onyx embolization is a valuable alternative to surgery in the treatment of jugulotympanic and vagal paragangliomas; tympanic surgery or radiosurgery of the skull base should be considered in selected cases. Preoperative Onyx embolization of CBPs is not recommended.
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Affiliation(s)
- Caterina Michelozzi
- Dipartimento di Radiologia diagnostica e Interventistica, Scuola di Specialità di Radiodiagnostica, Università degli Studi di Milano, Ospedale Sanpaolo, Milano, Italy Neuroradiology Department, University Hospital of Purpan, Toulouse, France
| | | | - Victor Cuvinciuc
- DISIM, Neuroradiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Tall
- Neuroradiology Department, University Hospital of Purpan, Toulouse, France
| | - Fabrice Bonneville
- Neuroradiology Department, University Hospital of Purpan, Toulouse, France
| | - Bernard Fraysse
- Department of Otology-Neuro-otology and Skull Base Surgery, University Hospital of Purpan, Toulouse, France
| | - Olivier Deguine
- Department of Otology-Neuro-otology and Skull Base Surgery, University Hospital of Purpan, Toulouse, France
| | - Elie Serrano
- Department of ENT, University Hospital of Rangueil-Larrey, Toulouse, France
| | - Christophe Cognard
- Neuroradiology Department, University Hospital of Purpan, Toulouse, France
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Patnaik U, Prasad S, Medina M, Al-Qahtani M, D’Orazio F, Falcioni M, Piccirillo E, Russo A, Sanna M. Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas. Am J Otolaryngol 2015; 36:382-9. [PMID: 25697086 DOI: 10.1016/j.amjoto.2015.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/10/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the long term outcomes after surgery in tympanomastoid paragangliomas. STUDY DESIGN Retrospective study. METHODS The charts of 145 patients with tympanomastoid paragangliomas managed between 1988 and 2013 were reviewed. The clinical features, audiological data, pre- and postoperative notes were noted. The tumors were staged according to the modified Fish and Mattox classification. The surgical approaches for all patients were formulated according to the surgical algorithm developed at our center. RESULTS 34 (23.5%), 46 (31.7%), 22 (15.2%), 18 (12.4%) and 25 (17.2%) patients were diagnosed to have TMP class A1, A2, B1, B2 and B3 tumors respectively. Gross tumor resection was achieved in 141 (97.2%) patients. The facial nerve was uncovered in four patients and infiltrated in three. The cochlea was found eroded in seven cases. The mean follow-up was 48.4 months. Recurrence was seen in one patient (0.7%). In the cases where the facial nerve was preserved (n=143), the nerve function was graded as HB grade 1 in 138 patients (97%). Postoperatively, the mean AC showed an improvement in all categories except in class B2 and B3, which corresponds to the classes that include patients who underwent subtotal petrosectomy. CONCLUSION We report the long term surgical outcomes in tympanomastoid paragangliomas in the largest series published till date. It is possible to completely eradicate all types of tympanomastoid paragangliomas with minimum sequelae by choosing the correct surgical approach to achieve adequate exposure for individual tumor classes as described in our classification and algorithm. LEVEL OF EVIDENCE IIb.
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Wanna GB, Sweeney AD, Haynes DS, Carlson ML. Contemporary Management of Jugular Paragangliomas. Otolaryngol Clin North Am 2015; 48:331-41. [DOI: 10.1016/j.otc.2014.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Paragangliomas (PGLs) are rare vascular, neuroendocrine tumors of paraganglia, which are associated with either sympathetic tissue in adrenal (pheochromocytomas (PCCs)) and extraadrenal (sympathetic paraganglioma (sPGLs)) locations or parasympathetic tissue of the head and neck paragangliomas (HNPGLs). As HNPGLs are usually benign and most tumors grow slowly, a wait-and-scan policy is often advised. However, their location in the close proximity to cranial nerves and vasculature may result in considerable morbidity due to compression or infiltration of the adjacent structures, necessitating balanced decisions between a wait-and-see policy and active treatment. The main treatment options for HNPGL are surgery and radiotherapy. In contrast to HNPGLs, the majority of sPGL/PCCs produces catecholamines, in advanced cases resulting in typical symptoms and signs such as palpitations, headache, diaphoresis, and hypertension. The state-of-the-art diagnosis and localization of sPGL/PCCs are based on measurement of plasma and/or 24-h urinary excretion of (fractionated) metanephrines and methoxytyramine (MT). sPGL/PCCs can subsequently be localized by anatomical (computed tomography and/or magnetic resonance imaging) and functional imaging studies (123I-metaiodobenzylguanidine-scintigraphy, 111In-pentetreotide scintigraphy, or positron emission tomography with radiolabeled dopamine or dihydroxyphenylalanine). Although most PGL/PCCs are benign, factors such as genetic background, tumor size, tumor location, and high MT levels are associated with higher rates of metastatic disease. Surgery is the only curative treatment. Treatment options for patients with metastatic disease are limited. PGL/PCCs have a strong genetic background, with at least one-third of all cases linked with germline mutations in 11 susceptibility genes. As genetic testing becomes more widely available, the diagnosis of PGL/PCCs will be made earlier due to routine screening of at-risk patients. Early detection of a familial PGL allows early detection of potentially malignant PGLs and early surgical treatment, reducing the complication rates of this operation.
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Affiliation(s)
- Eleonora P Corssmit
- Department of EndocrinologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment and Division of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Department of EndocrinologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment and Division of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham ER, Archer SM, Blakley BW, Carter JM, Granieri EC, Henry JA, Hollingsworth D, Khan FA, Mitchell S, Monfared A, Newman CW, Omole FS, Phillips CD, Robinson SK, Taw MB, Tyler RS, Waguespack R, Whamond EJ. Clinical Practice Guideline. Otolaryngol Head Neck Surg 2014; 151:S1-S40. [DOI: 10.1177/0194599814545325] [Citation(s) in RCA: 378] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient’s quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome. Purpose The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. Action Statements The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following recommendations: Clinicians should (a) perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus; (b) obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties; (c) distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care; (d) educate patients with persistent, bothersome tinnitus about management strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus. The panel recommended against (a) antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus. The development group provided the following options: Clinicians may (a) obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status); and (b) recommend sound therapy to patients with persistent, bothersome tinnitus. The development group provided no recommendation regarding the effect of acupuncture in patients with persistent, bothersome tinnitus.
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Affiliation(s)
- David E. Tunkel
- Otolaryngology–Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA
| | - Carol A. Bauer
- Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Gordon H. Sun
- Partnership for Health Analytic Research, LLC, Los Angeles, California, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, State University of New York at Downstate Medical Center, Brooklyn, New York, USA
| | | | - Eugene R. Cunningham
- Department of Research and Quality Improvement, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Sanford M. Archer
- Divisions of Rhinology & Sinus Surgery and Facial Plastic & Reconstructive Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Brian W. Blakley
- Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John M. Carter
- Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA
| | - Evelyn C. Granieri
- Division of Geriatric Medicine and Aging, Columbia University, New York, New York, USA
| | - James A. Henry
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon, USA
| | | | | | | | - Ashkan Monfared
- Department of Otology and Neurotology, The George Washington University, Washington, DC, USA
| | - Craig W. Newman
- Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | | | - C. Douglas Phillips
- Department of Head and Neck Imaging, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Shannon K. Robinson
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Malcolm B. Taw
- Department of Medicine, UCLA Center for East-West Medicine, Los Angeles, California, USA
| | - Richard S. Tyler
- Department of Otolaryngology–Head and Neck Surgery, The University of Iowa, Iowa City, Iowa, USA
| | - Richard Waguespack
- Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Elizabeth J. Whamond
- Consumers United for Evidence-Based Healthcare, Fredericton, New Brunswick, Canada
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Wanna GB, Sweeney AD, Carlson ML, Latuska RF, Rivas A, Bennett ML, Netterville JL, Haynes DS. Subtotal Resection for Management of Large Jugular Paragangliomas with Functional Lower Cranial Nerves. Otolaryngol Head Neck Surg 2014; 151:991-5. [DOI: 10.1177/0194599814552060] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate tumor control following subtotal resection of advanced jugular paragangliomas in patients with functional lower cranial nerves and to investigate the utility of salvage radiotherapy for residual progressive disease. Study Design Case series with planned chart review. Setting Tertiary academic referral center. Subjects and Methods Patients who presented with advanced jugular paragangliomas and functional lower cranial nerves were analyzed. Primary outcome measures included extent of resection, long-term tumor control, need for additional treatment, and postoperative lower cranial nerve function. Results Twelve patients (mean age, 46.2 years; 7 women, 58.3%) who met inclusion criteria were evaluated between 1999 and 2013. The mean postoperative residual tumor volume was 27.7% (range, 3.5%-75.0%) of the preoperative volume. When the residual tumor volume was less than 20% of the preoperative volume, no tumor growth occurred over an average of 44.6 months of follow-up ( P < .01). Four tumors (33.3%) demonstrated serial growth at a mean of 23.5 months following resection, 2 of which were treated with salvage stereotactic radiotherapy providing control through the last recorded follow-up. No patient experienced permanent postoperative lower cranial neuropathy as a result of surgery. Conclusion Subtotal resection of jugular paragangliomas with preservation of the lower cranial nerves is a viable management strategy. If more than 80% of the preoperative tumor volume is resected, the residual tumor seems less likely to grow.
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Affiliation(s)
- George B. Wanna
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alex D. Sweeney
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard F. Latuska
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alejandro Rivas
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L. Bennett
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James L. Netterville
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S. Haynes
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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The Role of Wait-and-Scan and the Efficacy of Radiotherapy in the Treatment of Temporal Bone Paragangliomas. Otol Neurotol 2014; 35:922-31. [DOI: 10.1097/mao.0000000000000386] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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34
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Sanna M, Shin SH, Piazza P, Pasanisi E, Vitullo F, Di Lella F, Bacciu A. Infratemporal fossa approach type a with transcondylar-transtubercular extension for Fisch type C2 to C4 tympanojugular paragangliomas. Head Neck 2013; 36:1581-8. [DOI: 10.1002/hed.23480] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/20/2013] [Accepted: 08/23/2013] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mario Sanna
- Gruppo Otologico Piacenza-Rome and University of Chieti; Italy
| | - Seung-Ho Shin
- Department of Otolaryngology-Head and Neck Surgery; CHA University; Seongnam Republic of Korea
| | - Paolo Piazza
- Department of Neuroradiology; University-Hospital of Parma; Parma Italy
| | - Enrico Pasanisi
- Department of Clinical and Experimental Medicine; Otolaryngology Unit, University-Hospital of Parma; Parma Italy
| | | | | | - Andrea Bacciu
- Department of Clinical and Experimental Medicine; Otolaryngology Unit, University-Hospital of Parma; Parma Italy
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Papaspyrou K, Welkoborsky HJ, Gouveris H, Mann WJ. Malignant and benign sinonasal paragangliomas. Laryngoscope 2013; 123:1830-6. [PMID: 23371358 DOI: 10.1002/lary.23985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/23/2012] [Accepted: 12/18/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To report on the clinical course and management of sinonasal paragangliomas (PGLs). STUDY DESIGN AND METHODS Retrospective chart review of six patients with PGLs of the nasal cavity and paranasal sinuses. RESULTS Three patients had tumors with malignant clinical behavior with cerebral metastases or infiltration of brain and local recurrence, despite surgery and/or radiotherapy, while three patients demonstrated a benign course. CONCLUSION Sinonasal paragangliomas are frequently malignant. If malignant, they are very aggressive, with rapid local spread as well as high metastatic potential despite surgical resection; and they have a poor prognosis. Malignancy cannot be diagnosed on histology, but only on the basis of clinical behavior. Intracranial metastasis is commonly expected. Long-term follow-up, with particular emphasis put on the intracranial structures, is mandatory as recurrences or metastasis may occur even after a long time interval.
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Affiliation(s)
- Konstantinos Papaspyrou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany.
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Phillips GS, LoGerfo SE, Richardson ML, Anzai Y. Interactive Web-based Learning Module on CT of the Temporal Bone: Anatomy and Pathology. Radiographics 2012; 32:E85-105. [DOI: 10.1148/rg.323115117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lope Ahmad RAR, Sivalingam S, Konishi M, De Donato G, Sanna M. Oncologic outcome in surgical management of jugular paraganglioma and factors influencing outcomes. Head Neck 2012; 35:527-34. [PMID: 22544660 DOI: 10.1002/hed.22987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify the factors that may influence the management outcome in patients with jugular paragangliomas. METHODS The surgical records of 121 cases of jugular paraganglioma (Fisch classifications C and D) were reviewed. RESULTS The average follow-up was 88 months. Intracranial extension (ICE; Fisch classification De and Di) constitutes 55.4% of the cases. Two cases had a malignant jugular paraganglioma. Complete tumor resection was achieved in 81.8% of the cases, and there was evidence of recurrence in 4.0% from this group. Surgical tumor control was achieved in 96% of cases. Perioperative complications consisted mainly of cerebrospinal fluid leakage in 1.6% of the cases. The lower cranial nerve (CN) was preserved in 63% of the patients mainly in the cases without ICE. CONCLUSION The infratemporal fossa approach type A allows for complete tumor resection with low perioperative morbidity and recurrence rates. The significant influential factors were the severity of ICE and internal carotid artery involvement.
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Affiliation(s)
- Raja Ahmad R Lope Ahmad
- Department of Otolaryngology-Head & Neck Surgery, International Islamic University, Malaysia, Kuantan, Malaysia.
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Künzel J, Iro H, Hornung J, Koch M, Brase C, Klautke G, Zenk J. Function-preserving therapy for jugulotympanic paragangliomas: A retrospective analysis from 2000 to 2010. Laryngoscope 2012; 122:1545-51. [DOI: 10.1002/lary.23268] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/30/2012] [Indexed: 11/08/2022]
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Offergeld C, Brase C, Yaremchuk S, Mader I, Rischke HC, Gläsker S, Schmid KW, Wiech T, Preuss SF, Suárez C, Kopeć T, Patocs A, Wohllk N, Malekpour M, Boedeker CC, Neumann HPH. Head and neck paragangliomas: clinical and molecular genetic classification. Clinics (Sao Paulo) 2012; 67 Suppl 1:19-28. [PMID: 22584701 PMCID: PMC3328838 DOI: 10.6061/clinics/2012(sup01)05] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Head and neck paragangliomas are tumors arising from specialized neural crest cells. Prominent locations are the carotid body along with the vagal, jugular, and tympanic glomus. Head and neck paragangliomas are slowly growing tumors, with some carotid body tumors being reported to exist for many years as a painless lateral mass on the neck. Symptoms depend on the specific locations. In contrast to paraganglial tumors of the adrenals, abdomen and thorax, head and neck paragangliomas seldom release catecholamines and are hence rarely vasoactive. Petrous bone, jugular, and tympanic head and neck paragangliomas may cause hearing loss. The internationally accepted clinical classifications for carotid body tumors are based on the Shamblin Class I-III stages, which correspond to postoperative permanent side effects. For petrous-bone paragangliomas in the head and neck, the Fisch classification is used. Regarding the molecular genetics, head and neck paragangliomas have been associated with nine susceptibility genes: NF1, RET, VHL, SDHA, SDHB, SDHC, SDHD, SDHAF2 (SDH5), and TMEM127. Hereditary HNPs are mostly caused by mutations of the SDHD gene, but SDHB and SDHC mutations are not uncommon in such patients. Head and neck paragangliomas are rarely associated with mutations of VHL, RET, or NF1. The research on SDHA, SDHAF2 and TMEM127 is ongoing. Multiple head and neck paragangliomas are common in patients with SDHD mutations, while malignant head and neck paraganglioma is mostly seen in patients with SDHB mutations. The treatment of choice is surgical resection. Good postoperative results can be expected in carotid body tumors of Shamblin Class I and II, whereas operations on other carotid body tumors and other head and neck paragangliomas frequently result in deficits of the cranial nerves adjacent to the tumors. Slow growth and the tendency of hereditary head and neck paragangliomas to be multifocal may justify less aggressive treatment strategies.
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Affiliation(s)
- Christian Offergeld
- Department of Otorhinolaryngology, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
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External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Insights Imaging 2011; 3:33-48. [PMID: 22695997 PMCID: PMC3292638 DOI: 10.1007/s13244-011-0126-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 09/04/2011] [Accepted: 09/09/2011] [Indexed: 12/04/2022] Open
Abstract
Objective Pathology of the external and middle ear is the most frequent reason to prescribe antibiotics and perform surgery in children and young adults. In the majority of cases imaging studies are not performed; the need for imaging comes when complications are suspected or when treatment is not effective. This paper discusses indications for temporal bone imaging studies and presents the most frequent pathological conditions, together with differential diagnosis, clinical symptoms and methods of treatment. Methods and Results This pictorial review describes major external and middle ear diseases, with special regard to clinical findings and appropriate reporting. Conclusions Apprehension of the complete clinical picture, together with imaging clues, narrows differential diagnosis and helps avoid mistakes. Evaluation of temporal bone pathologies requires close cooperation between the clinician and radiologist.
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Niemczyk K, Lukawska I, Kulesza A, Bruzgielewicz A, Bartoszewicz R. [Treatment results of temporal bone area paragangliomas]. Otolaryngol Pol 2011; 65:31-7. [PMID: 22000248 DOI: 10.1016/s0030-6657(11)70706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 08/09/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Temporal bone paragangliomas are rare, benign neuroendocrine tumors. Depend on their location at skull base, they can extend intracranially and extracranially. They characterize by slowly growth and late nonspecific clinical manifestation. Location of tumor and anatomical condition require suitable operational technique and cause related complications. AIM The aim of this study was analysis of surgical procedure and evaluation of treatment results of patients with paragangliomas of the temporal bone hospitalized in Department of Otolaryngology of Warsaw Medical University in years 2000-2010. MATERIAL AND METHODS 34 cases of patients were retrospectively studied. Clinical data, level of tumor advancement according to Glasscock & Jackson and Fisch classification were analyzed. Intraoperative and imaging studies data were used to evaluate extent of lesions. Suitable operative approaches and outcome of treatment were also analyzed. CONCLUSION In group of 34 patients 26 of them had monocentric and 8 multicentric neoplasms. Age ranged 15-73-years-old. Most common symptoms were: loss of hearing, tinnitus and headache. Preoperative embolization was carried in 10 cases. Most common surgery technique: tympanotomy and hypotympanotomy posterior and infratemporal fossa of Fisch type A approaches. Radiotherapy was used in 2 cases and surgery with radiation therapy in 7 cases. Most commonly observed complication in surgical treatment was intermittent paresis.
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Affiliation(s)
- Kazimierz Niemczyk
- Katedra i Klinika Otolaryngologii, Warszawskiego Uniwersytetu Medycznego.
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Ladziński P, Majchrzak H, Kaspera W, Maliszewski M, Majchrzak K, Tymowski M, Adamczyk P. Early and long-term results of the treatment of jugular paragangliomas using different ranges of surgical approach. Neurol Neurochir Pol 2011; 45:213-25. [PMID: 21866478 DOI: 10.1016/s0028-3843(14)60074-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The applied approach to the jugular foramen is a combination of the juxtacondylar approach with the subtemporal fossa approach type A. The purpose of this study is to present our results of treatment of jugular paragangliomas using the aforementioned approach. MATERIAL AND METHODS Twenty-one patients (15 women, 6 men) with jugular paragangliomas were included in the study. The neurological status of the patients was assessed before and after surgery as well as at the conclusion of treatment. The approximate volume of the tumour, its relation to large blood vessels, cranial nerves and brainstem, as well as consistency and vascularity were also assessed. RESULTS The duration of symptoms ranged from 3 to 74 months. In 86% of patients hearing loss was the predominant symptom. The less frequent symptoms included pulsatile tinnitus in the head, dysphagia and dizziness. Approximate volume of the tumours ranged from 2 to 109 cm3. A gross total resection was achieved in 71.5% of patients. The postoperative performance status improved in 38% of patients, did not change in 38% and deteriorated in 24% of patients. CONCLUSIONS A proper selection of the range of the approach to jugular foramen paragangliomas based on their topography and volume reduces perioperative injury without negative consequences for the radicality of the resection.
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Abstract
This article presents our experience with the management and outcomes of patients with sporadic glomus jugular tumors using a tailored surgical approach. We conducted a retrospective study of 49 patients with sporadic jugular paragangliomas. Thirty-eight patients (78%) were treated using the transmastoid-infralabyrinthine (TM-IL) approach, and 11 (22%) were treated with the infratemporal fossa type A (IFT-A) approach. Mean follow-up period was 8.2 years. Surgical cure was achieved in all but 6 patients using the TM-IL approach (84%) and in 8 of 11 patients with the IFT-A approach (73%). A House-Brackmann grade of I or II facial nerve function was obtained postoperatively in 84% of TM-IL cases and in 56% of the IFT-A cases. The incidence of other complications-meningitis and transient cerebrospinal fluid leak-was higher in the TM-IL group (8% and 13%, respectively) compared with the IFT-A group (0% and 9%, respectively). We concluded that the TM-IL approach with individually tailored management of the facial nerve fulfills the long-term requirements of both keeping good postoperative facial function and obtaining adequate tumor resection.
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Affiliation(s)
- Mislav Gjuric
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
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Prajsnar A, Balak N, Walter GF, Stan AC, Deinsberger W, Tapul L, Bayindir C. Recurrent paraganglioma of Meckel's cave: Case report and a review of anatomic origin of paragangliomas. Surg Neurol Int 2011; 2:45. [PMID: 21660268 PMCID: PMC3108444 DOI: 10.4103/2152-7806.79763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/22/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Paragangliomas are rare, usually benign tumors of neural crest origin. They account for only 0.6% of all head and neck tumors. In the craniocervical area, they are more common in the carotid body and tympanico-jugular regions. To the authors' knowledge, a case of paraganglioma in Meckel's cave has not yet been reported in the medical literature. The pathogenesis and natural history of paragangliomas are still not well understood. We present a case of recurrent paraganglioma in Meckel's cave. CASE DESCRIPTION A 53-year-old woman was diagnosed with trigeminal neuralgia, dysesthesia and hypoesthesia on the left side of the face, hearing disturbance and a history of chronic, persistent temporal headaches. Magnetic resonance imaging (MRI) showed a lesion located in Meckel's cave on the left side, extending to the posterior cranial fossa and compressing the left cerebral peduncle. The lesion was first thought to be a recurrence of an atypical meningioma, as the pathologist described it in the tissue specimen resected 3 years earlier, and a decision for re-operation was made. A lateral suboccipital approach to the lesion was used under neuronavigational guidance. The tumor was removed, and histological examination proved the lesion to be a paraganglioma. Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention. CONCLUSIONS A paraganglioma in Meckel's cave is an uncommon tumor in this location. Although ectopic paragangliomas have been described in the literature, a paraganglioma atypically located in Meckel's cave makes a topographic correlation difficult, mainly because paraganglionic cells are usually not found in Meckel's cave. Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.
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Affiliation(s)
- Anna Prajsnar
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | - Naci Balak
- Goztepe Education and Research Hospital, Istanbul, Turkey
| | | | | | | | - Leyla Tapul
- Department of Histology, Istanbul Faculty of Medicine, University of Istanbul, Turkey
| | - Cicek Bayindir
- Department of Neuropathology, Istanbul Faculty of Medicine, University of Istanbul, Turkey
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Abstract
ABSTRACT
Paragangliomas or glomus tumors are usually low-grade hypervascular tumors occurring in various sites of the autonomic nervous system including the carotid body, glomus vagale and glomus tympanicum. Although the grading of the tumor suggests a benign clinical course, the tumor can be locally malignant and surgical management is sometimes difficult because of postoperative functional loss and local recurrence. In addition, the operative field is generally very bloody and tissue planes are not always well-defined.
Though the optimal management of paraganglioma occurs in a multidisciplinary setting, considering the excellent local control rates with primary irradiation alone, a nonsurgical definitive approach should initially be considered.
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Prasad SC, Thada N, Pallavi, Prasad KC. Paragangliomas of the Head & Neck: the KMC experience. Indian J Otolaryngol Head Neck Surg 2011; 63:62-73. [PMID: 22319720 PMCID: PMC3109956 DOI: 10.1007/s12070-010-0107-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 05/16/2010] [Indexed: 12/11/2022] Open
Abstract
To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin's Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.
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Affiliation(s)
- Sampath Chandra Prasad
- Department of Otolaryngology—Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Mangalore, 575001 South Kanara, Karnataka India
- First Floor, Nethravathi Building, Balmatta, Mangalore, 575001 South Kanara, Karnataka India
| | - Nikhil Thada
- Department of Otolaryngology—Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Mangalore, 575001 South Kanara, Karnataka India
| | - Pallavi
- Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Manipal University, Mangalore, Karnataka India
| | - Kishore Chandra Prasad
- Department of Otolaryngology—Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Mangalore, 575001 South Kanara, Karnataka India
- Department of Otolaryngology—Head & Neck Surgery, District Government Wenlock Hospital, Mangalore, Karnataka India
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Aschenbach R, Basche S, Esser D, Vogl TJ. Usefulness of ultrafast dynamic 3D-T1w data acquisition in detection of hypervascular lesions of the middle ear: first experience. Eur J Radiol 2010; 81:257-61. [PMID: 21123017 DOI: 10.1016/j.ejrad.2010.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 10/28/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate ultrafast dynamic 3D-T1w acquisition for improved detection of tympanic hypervascularized lesions. METHODS Retrospective evaluation of a total of 50 patients referred from ENT-Department for suspected tympanic lesion. All underwent magnetic resonance imaging including ultrafast dynamic 3D-T1w acquisition imaging. Quantitative and qualitative evaluation was performed as well as statistical analysis. Comparison with intra-operative results. RESULTS 12/50 patients showed a hypervascularized lesion proved intraoperative as 8 paragangliomas, 2 adenoms, 1 hemangioma and 1 neurinoma. 8/50 do not show hypervascularization though an enhancement was detected. Intra-operative granulation tissue was found. 30 patients did not show any lesions or enhancement. Sensitivity and specificity was 100%/100% for ultrafast dynamic imaging. CONCLUSION Additional ultrafast dynamic 3D-T1w imaging is superior to conventional imaging in detection of hypervascularized lesions.
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Affiliation(s)
- René Aschenbach
- HELIOS Klinikum Erfurt GmbH, Institute for Diagnostic and Interventional Radiology and Neuroradiology, Nordhauser Str 74, 99089 Erfurt, Germany.
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Affiliation(s)
- Jason C Fowler
- Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Sanna M, Fois P, Pasanisi E, Russo A, Bacciu A. Middle ear and mastoid glomus tumors (glomus tympanicum): an algorithm for the surgical management. Auris Nasus Larynx 2010; 37:661-8. [PMID: 20400250 DOI: 10.1016/j.anl.2010.03.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Revised: 02/09/2010] [Accepted: 03/04/2010] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Glomus tumors are slow-growing benign lesions and represent the most common primary neoplasms of the middle ear. The objective of the present study is to report our surgical strategy in the management of glomus tympanicum tumors. METHODS Between December 1988 and July 2008, 68 patients with histologically confirmed glomus tympanicum tumor underwent surgical treatment. The follow-up of the series ranged from 6 to 194 months (mean, 33.4 months). RESULTS Distribution of tumors according to Fisch and Mattox classification was as follows: type A, 44 cases (64.7%); type B, 24 cases (35.3%). All of the 44 Class A tumors were safely removed via either a stapedectomy-type transcanal approach or a retroauricolar-transcanal approach. Five patients with Class B tumors were operated on through a transmastoid approach. Nineteen patients with larger Class B tumors underwent a subtotal petrosectomy with blind sac closure of the external auditory canal and middle ear obliteration. Gross total tumor removal was achieved in all 68 cases. In one case (1.4%) there was recurrence after 9 years, for which the patient was re-operated. No residual/recurrence has been detected on computed tomography in the rest of the patients. CONCLUSION Surgical excision of glomus tympanicum tumors is a safe procedure, allowing total tumor removal with minimal morbidity, a low recurrence rate, and a low complication rate.
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The glossopharyngeal, vagus and spinal accessory nerves. Eur J Radiol 2010; 74:359-67. [PMID: 20233644 DOI: 10.1016/j.ejrad.2009.05.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/06/2009] [Indexed: 11/21/2022]
Abstract
The glossopharyngeal, vagus and spinal accessory nerves are closely related anatomically, and to a certain extent, functionally. We present an overview of their anatomy, highlighting the important clinical and imaging implications. The main pathologic lesions arising from these nerves are also discussed and the imaging features reviewed.
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