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Salem MA, Ghoneim M, Ahmed SS, Elsobki A, Elzhzahy AA, Hemdan A. Endoscopic transcanal coblation excision of glomus tympanicum: a novel technique. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08660-7. [PMID: 38689036 DOI: 10.1007/s00405-024-08660-7] [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: 01/07/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To evaluate the feasibility of coblation in excision of glomus tympanicum tumors. PATIENTS AND METHODS A retrospective study carried out over 28 patients with types I and II glomus tympanicum tumors according to GLASSCOCK-JACKSON classification. Preoperative radiological and endocrinal evaluation were performed. All patients underwent endoscopic transcanal excision of their glomus tympanicum tumors using coblation. RESULTS None of the patients developed recurrence during the 1-year follow up period proved radiologically. None of the patients developed facial palsy postoperatively. Differences between preoperative and postoperative dizziness and taste disturbance were statistically non-significant. Tinnitus disappeared completely in 22 patients postoperatively. A statistically significant reduction in Tinnitus Handicap Inventory (THI) after surgery was found. Statistically significant reductions in postoperative air conduction (AC) threshold and air bone gap (ABG) were recorded while bone conduction (BC) threshold showed statistically non-significant change. CONCLUSION Coblation is an effective and safe tool in excision of glomus tympanicum tumors. Further studies comparing coblation with laser and piezosurgery are strongly recommended.
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Affiliation(s)
- Mohammed Abdelbadie Salem
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Mahitab Ghoneim
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Sally Sameh Ahmed
- Department of Endocrinology, Diabetes and Metabolism, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Elsobki
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Abdoo Elzhzahy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Hemdan
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt.
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Ghanaati H, Zarei D, Issaiy M, Ghavami N, Shakiba M, Zebardast J, Abbastabar H, Jalali AH, Firouznia K. Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications. Cardiovasc Intervent Radiol 2024; 47:416-431. [PMID: 38528173 DOI: 10.1007/s00270-024-03687-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/16/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). MATERIALS AND METHODS A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. RESULTS This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473-799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350-624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11-32%), and vagal nerve deficits in 22% (95% CI 13-31%). CONCLUSION This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data.
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Affiliation(s)
- Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Diana Zarei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbod Issaiy
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Ghavami
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Jayran Zebardast
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hedayat Abbastabar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
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Akhtar N, Shahid F, Ali AS, Muhammad QUA, Azam NM, Dhakal B, Ibrahim M, Nadeem N. Paraganglioma at the cerebellopontine angle: A case report and review of literature. Clin Case Rep 2024; 12:e8584. [PMID: 38444925 PMCID: PMC10912100 DOI: 10.1002/ccr3.8584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Paragangliomas (PGLs) are rare neuroendocrine tumors. Sometimes, these tumors secrete excessive catecholamines, which results in the manifestations of various signs and symptoms, usually with a triad of hypertension, tachycardia, and headache. We report the case of a 42-year-old woman presenting with uncontrolled hypertension, right facial palsy, vomiting, and disturbed gait. Diagnosis for PGL was confirmed on postoperative histological examination of the excised mass and correlated with preoperative clinical and radiological findings. Tumor excision was done via a suboccipital craniotomy approach. Our case presents the typically severe features of a jugulotympanic PGL, but most importantly, it highlights the necessity of biochemical diagnosing, thorough probing of the causes of hypertension, and a multi-disciplinary approach in dealing with these tumors. Moreover, the case emphasizes necessitating the use of preoperative embolization in vascular tumors of the head and neck to avoid a hemorrhagic crisis during surgery. Unfortunately, due to a lack of adequate hospital funds, the surgeon had to proceed without preoperative embolization. Despite such a risk, the excision was a success.
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Affiliation(s)
- Nadeem Akhtar
- Department of NeurosurgeryRawalpindi Teaching HospitalPunjabPakistan
| | - Fatimah Shahid
- Department of NeurosurgeryRawalpindi Medical UniversityPunjabPakistan
| | | | | | - Noor Mahal Azam
- Department of NeurosurgeryRawalpindi Medical UniversityPunjabPakistan
| | - Bishal Dhakal
- Department of NeurologyNepalese Army Institute of Health SciencesKathmanduNepal
| | - Muhammad Ibrahim
- Department of NeurosurgeryRawalpindi Medical UniversityPunjabPakistan
| | - Nehal Nadeem
- Department of Internal MedicineShifa College of MedicineIslamabadPakistan
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Marini K, Florou V, Skliris JP, Marangos N, Kamargiannis N. Jugulotympanic Paraganglioma With Preoperative Embolization That Led to Facial Nerve Paralysis and Surgical Rerouting of the Nerve. Cureus 2023; 15:e41997. [PMID: 37593266 PMCID: PMC10428081 DOI: 10.7759/cureus.41997] [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: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Paragangliomas are mostly benign, slow-growing, hypervascular tumors originating from neural crest derivatives. Head and neck (H&N) paragangliomas represent <1% of all H&N tumors and <5% are malignant. They are mostly non-secreting tumors that originate from autonomous parasympathetic paraganglia. We present a case of right middle ear jugulotympanic paraganglioma, a subtype of H&N paragangliomas, which had been misdiagnosed as otosclerosis for about 10 years. The patient was suffering from worsening tinnitus along with hearing impairment. High clinical suspicion of jugular paraganglioma prevented us from taking a biopsy. Complete surgical excision after preoperative embolization was decided. Embolization resulted in facial nerve paralysis, however, facial nerve rerouting was performed during the complete surgical excision of the tumor. The patient remains disease-free three years postoperatively, with House-Brackmann III facial nerve paralysis.
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Affiliation(s)
- Katerina Marini
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Gennimatas' General Hospital, Thessaloniki, GRC
| | - Vasiliki Florou
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Gennimatas' General Hospital, Thessaloniki, GRC
| | | | - Nikolaos Marangos
- Department of Otolaryngology-Head and Neck Surgery, Center of ENT and Head and Neck Surgery, Rottweil, DEU
| | - Nikolaos Kamargiannis
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Gennimatas' General Hospital, Thessaloniki, GRC
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Lungu CN, Creteanu M, Olteanu G, Romila A. Glomangioma Supply from Profunda Femoris Artery in Peripheral Artery Disease. Clin Pract 2022; 12:755-759. [PMID: 36136872 PMCID: PMC9498625 DOI: 10.3390/clinpract12050078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Abstract
This is a case report of a 5.6 cm glomangioma supplied by the femoral profunda artery in a 66-year-old male patient with severe peripheral artery disease. The patient complained of discomfort and mild pain at the place of the lesion and an accelerated growth rate in the last two months. A nodular mass located laterally on the left foot, elastic, covered with a thin skin, and mobile, was noted on the clinical exam. Doppler exam demonstrated an active vascular supply. CT angiography showed a femoral profunda artery blood supply and a severe asymptomatic bilateral peripheral artery disease (PAD). The lesion was removed entirely by surgery. A microscopy exam revealed a glomangioma. After surgery, the patient recovered unevenly. However, the patient experienced wound-healing issues that resolved after four weeks of surgery. Although the patient’s PAD was severe, the lesion presented with a burst in dimensions weeks before surgery.
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Affiliation(s)
- Claudiu N. Lungu
- Department of Surgery, Clinical Country Emergency Hospital, 810249 Galati, Romania
- Correspondence:
| | - Mihai Creteanu
- Department of Radiology, Country Emergency Hospital, 720001 Suceava, Romania
| | - Gabriel Olteanu
- Department of Surgery, Clinical Country Emergency Hospital, 400000 Cluj, Romania
| | - Aurelia Romila
- Department of Gerontology and Geriatrics, Clinical Country Emergency Hospital, 810249 Galati, Romania
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Rahmani Z, Khajavi M, Bazgir N, Kordjazi M. A rare presentation of head and neck Paragangliomas in parotid gland: A case report. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Balaban Genc ZC, Filizoglu N, Ozguven S. Recurrent Glomus Jugulare Tumor Invading the Cerebellum on 68Ga-DOTATATE PET/CT. Clin Nucl Med 2022; 47:e406-e407. [PMID: 35261358 DOI: 10.1097/rlu.0000000000004117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Glomus tumors are rare, slow-growing extra-adrenal paragangliomas of the head and neck. Treatment and prevention of neurological deficits become more difficult as these tumors aggressively grow in size and infiltrate adjacent anatomical structures. Because glomus tumors are paragangliomas of neuroendocrine origin, 68Ga-DOTATATE PET/CT can be used as imaging method in the diagnosis and follow-up. In this case, we presented a recurrent glomus jugulare tumor that invaded to the cerebellum on 68Ga-DOTATATE PET/CT imaging.
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Affiliation(s)
- Zeynep Ceren Balaban Genc
- From the Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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Ho ML. Pediatric Neck Masses: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:1-14. [PMID: 34836558 DOI: 10.1016/j.rcl.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neck masses commonly present in children and several potential diagnostic and management pathways exist, though with a paucity of evidence-based recommendations. The purpose of this article is to evaluate the current literature and utilization of various diagnostic imaging modalities , with a review of imaging features and management pearls for pediatric neck masses. A comprehensive understanding and practical imaging workflow will guide optimal patient workup and management.
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Affiliation(s)
- Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive - ED4, Columbus, OH 43205, USA.
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Abstract
Glomus tumors (paragangliomas) are rare, usually benign, neuroendocrine tumors that arise from nonchromaffin cells and can be multifocal or familial. They grow slowly, often infiltratively and rarely form metastases. A distinction is made between carotid, jugular, tympanicum and vagal tumors. Depending on the location, clinical symptoms include neck swelling, hearing loss with pulse-synchronous ear noise or cranial nerve failures (IX-XI). Diagnosis is often delayed because of nonspecific symptoms. Diagnostically, tumor expansion and perfusion can be well visualized by color Doppler sonography. In the T2-weighted MRI, the tumor is hyperintense, after contrast agent administration a strong enhancement occurs due to the strong vascularization. In DSA (digital subtraction angiography), even small glomus tumors can be detected. Therapeutically, operative tumor resection after embolization with, e.g., polyvinyl alcohol particles or liquid embolization can be performed. If the patient is in poor general condition or if the tumor is inoperable, different treatment techniques (intensity-modulated radiotherapy, gamma or cyber-knife) may be considered as a conservative therapeutic alternative.
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