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Akpan I, Orabueze I, Ibizugbe U, Akhdar G, Agyeman WY. A Rare Differential of Epistaxis. Cureus 2024; 16:e59981. [PMID: 38854207 PMCID: PMC11162251 DOI: 10.7759/cureus.59981] [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: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Glomus tympanicum is a type of glomus tumor that affects the middle ear, located at the auricular branch of the vagus nerve. Glomus tumors, in general, are rare, slow-growing tumors and may not require surgery in some patients. It can be challenging to manage due to its hypervascularity, location, and advanced stage of diagnosis. Although glomus tympanicum commonly presents with pulsatile tinnitus and conductive hearing loss, it presented in our patient with large-volume hemoptysis and epistaxis, requiring urgent diagnostic and therapeutic interventions. We highlight the unique presentation of a 48-year-old female with sudden onset large-volume hemoptysis and epistaxis, leading to the discovery of a hypervascular glomus tympanicum in the right middle ear, identified via MRI. On arrival, her vitals were within normal limits, and a physical examination was pertinent for the obvious ongoing bleeding from her mouth. The examination revealed increased respiratory effort and bilateral crackles. Laboratory values were pertinent for hemoglobin of 11.8 g/dl. Ear examination revealed a large, vascular-appearing mass filling the right ear. An MRI of the face and neck showed an avidly enhancing 3.7 cm x 1.8 cm x 1.2 cm mass within the right middle ear and mastoid cavity, extending into the external auditory canal and through the eustachian tube into the nasopharynx. The mass was inseparable from the lateral border of the internal auditory canal in the petrous canal. Due to concern for glomus tympanicum, the patient underwent urgent embolization and subsequent tumor resection. Considering our patient initially presented large-volume hemoptysis, there was concern for alveolar hemorrhage. However, as she had no increased oxygen requirement, there was suspicion of massive epistaxis mistaken for hemoptysis. Due to large volume epistaxis, she underwent urgent embolization as resection could have been challenging due to increased vascularity. It is important to remember that massive epistaxis may not present with blood in the anterior nares, thereby delaying diagnosis and management. Furthermore, probing such tumors should be avoided as it may lead to life-threatening bleeding.
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Affiliation(s)
- Inemesit Akpan
- Internal Medicine, Piedmont Athens Regional Medical Center, Georgia, USA
| | - Ijeoma Orabueze
- Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | | | - Ghida Akhdar
- Internal Medicine, Piedmont Athens Regional Medical Center, Georgia, USA
| | - Walter Y Agyeman
- Internal Medicine, Piedmont Athens Regional Medical Center, Georgia, USA
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2
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Shiferaw MY, Teklemariam TL, Wondimagegnewu EZ, Gebrewahd DT, Yesuf EF, Mekuria BH, Abelti SB. Diffuse subarachnoid hemorrhage following ventriculo-peritoneal shunt insertion for acute obstructive hydrocephalus from large glomus jugulare tumor: case report. Front Surg 2024; 11:1353400. [PMID: 38645509 PMCID: PMC11027019 DOI: 10.3389/fsurg.2024.1353400] [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] [Received: 01/09/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Background Glomus jugulare tumors (GJTs) are rare intra-cranial tumors. Commonly, these lesions present with cranial nerve palsies, headaches, and hydrocephalus. Rarely, GJTs present with spontaneous subarachnoid hemorrhage. However, there has never been a report of diffuse subarachnoid hemorrhage following ventriculoperitoneal shunt insertion in a patient who developed hydrocephalus secondary to any brain tumor in general or glomus jugulare tumors in particular. Observation The authors presented an extremely rare complication of diffuse subarachnoid hemorrhage following the insertion of a ventriculoperitoneal shunt (VPS) in a 61-year-old female patient who was diagnosed to have both clinical and radiologic features of acute obstructive hydrocephalus secondary to a highly vascular huge glomus jugulare tumor. Conclusion Subarachnoid hemorrhage following ventriculoperitoneal shunt insertion for hydrocephalus caused by a mass lesion is an extremely rare complication. Preoperative CT angiography should be strongly considered to look for the associated vascular malformations in extremely vascularized mass lesions. Given the not ubiquitous availability of all therapeutic options for GJTs, especially in low and middle income settings contributes for the poor outcome of GJTs and it fosters a global neurosurgery agenda.
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Affiliation(s)
| | | | | | - Dejen Tekiea Gebrewahd
- Department of surgery, Neurosurgery Division, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ermias Fikru Yesuf
- Department of surgery, Neurosurgery Division, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bereket Hailu Mekuria
- Department of surgery, Neurosurgery Division, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sebboona Baisa Abelti
- Department of surgery, Neurosurgery Division, Addis Ababa University, Addis Ababa, Ethiopia
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3
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Castillo AL, Meybodi AT, Liu JK. Jugular Foramen Tumors: Surgical Strategies and Representative Cases. Brain Sci 2024; 14:182. [PMID: 38391756 PMCID: PMC10886589 DOI: 10.3390/brainsci14020182] [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: 12/10/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Jugular foramen tumors are complex lesions due to their relationship with critical neurovascular structures within the skull base. It is necessary to have a deep knowledge of the anatomy of the jugular foramen and its surroundings to understand each type of tumor growth pattern and how it is related to the surrounding neurovascular structures. This scope aims to provide a guide with the primary surgical approaches to the jugular foramen and familiarize the neurosurgeons with the anatomy of the region. (2) Methods and (3) Results: A comprehensive description of the surgical approaches to jugular foramen tumors is summarized and representative cases for each tumor type is showcased. (4) Conclusions: Each case should be carefully assessed to find the most suitable approach for the patient, allowing the surgeon to remove the tumor with minimal neurovascular damage. The combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach can be performed in a stepwise fashion for the resection of complex jugular foramen tumors.
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Affiliation(s)
- Andrea L Castillo
- Department of Neurological Surgery, New Jersey Medical School, Newark, NJ 07103, USA
- Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ 07039, USA
| | - Ali Tayebi Meybodi
- Department of Neurological Surgery, New Jersey Medical School, Newark, NJ 07103, USA
- Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ 07039, USA
| | - James K Liu
- Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ 07039, USA
- Skull Base Institute of New Jersey, Neurosurgeons of New Jersey, Livingston, NJ 07039, USA
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4
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Ceccato GHW, Foltran RS, Franke K, Dias MP, Sallé M, Borba LAB. Transmastoid/Infralabyrinthine Approach to the Jugular Foramen: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e361-e362. [PMID: 37350587 DOI: 10.1227/ons.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/19/2023] [Indexed: 06/24/2023] Open
Abstract
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE This approach is intended for tumors centered in the jugular foramen with extensions between intracranial and extracranial spaces, possible spread to the middle ear, and variable bony destruction. 1,2. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT Jugular foramen paragangliomas are complex lesions that usually invade and fill related venous structures. They present complex relationships with skull base neurovascular structures as internal carotid artery, lower cranial nerves (CNs), middle ear, and mastoid segment of facial nerve. In this way, it is essential to perform an adequate preoperative vascular study to evaluate sinus patency and the tumor blood supply, besides a computed tomography scan to depict bone erosion. ESSENTIAL STEPS OF THE PROCEDURE Mastoidectomy through an infralabyrinthine route up to open the lateral border of jugular foramen, allowing exposure from the sigmoid sinus to internal jugular vein. Skeletonization of facial canal without exposure of facial nerve is performed and opening of facial recess to give access to the middle ear in way of a fallopian bridge technique. 2-10. PITFALLS/AVOIDANCE OF COMPLICATIONS If there is preoperative preservation of lower CN function, it is important to not remove the anteromedial wall of the internal jugular vein and jugular bulb. In addition, facial nerve should be exposed just in case of preoperative facial palsy to decompress or reconstruct the nerve. VARIANTS AND INDICATIONS FOR THEIR USE Variations are related mainly with temporal bone drilling depending on the extensions of the lesion, its source of blood supply, and preoperative preservation of CN function.Informed consent was obtained from the patient for the procedure and publication of his image.Anatomy images were used with permission from:• Ceccato GHW, Candido DNC, and Borba LAB. Infratemporal fossa approach to the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.• Ceccato GHW, Candido DNC, de Oliveira JG, and Borba LAB. Microsurgical Anatomy of the Jugular Foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.
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Affiliation(s)
- Guilherme H W Ceccato
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Rodrigo S Foltran
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Kauê Franke
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Matheus P Dias
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Mikail Sallé
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Luis A B Borba
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Federal University of Paraná, Curitiba, Paraná, Brazil
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Curry SD, Kocharyan A, Lekovic GP. Multi-Disciplinary Approach to Skull Base Paragangliomas. Brain Sci 2023; 13:1533. [PMID: 38002493 PMCID: PMC10669609 DOI: 10.3390/brainsci13111533] [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: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of skull base paragangliomas has moved towards the use of cranial nerve preservation strategies, using radiation therapy and subtotal resection in instances when aiming for gross total resection would be expected to cause increased morbidity compared to the natural history of the tumor itself. The goal of this study was to analyze the role of surgery in patients with skull base paragangliomas treated with CyberKnife stereotactic radiosurgery (SRS) for definitive tumor control. A retrospective review identified 22 patients (median age 65.5 years, 50% female) treated with SRS from 2010-2022. Fourteen patients (63.6%) underwent microsurgical resection. Gross total resection was performed in four patients for tympanic paraganglioma (n = 2), contralateral paraganglioma (n = 1), and intracranial tumor with multiple cranial neuropathies (n = 1). Partial/subtotal resection was performed for the treatment of pulsatile tinnitus and conductive hearing loss (n = 6), chronic otitis and otorrhea (n = 2), intracranial extension (n = 1), or episodic vertigo due to perilymphatic fistula (n = 1). Eighteen patients had clinical and imaging follow-up for a mean (SD) of 4.5 (3.4) years after SRS, with all patients having clinical and radiological tumor control and no mortalities. Surgery remains an important component in the multidisciplinary treatment of skull base paraganglioma when considering other outcomes besides local tumor control.
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Affiliation(s)
- Steven D. Curry
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Armine Kocharyan
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Gregory P. Lekovic
- House Clinic, Los Angeles, CA 90017, USA
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
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Park HH, Yoo J, Oh HC, Froelich S, Lee KS. The Anterolateral Approach, Revisited for Benign Jugular Foramen Tumors With Predominant Extracranial Extension: Microsurgical Anatomy and Case Series (SevEN-012). Oper Neurosurg (Hagerstown) 2023; 25:e135-e146. [PMID: 37195061 DOI: 10.1227/ons.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/19/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and lateral exposure than the extreme lateral and endoscopic endonasal approach, respectively. We describe the microsurgical anatomy of ALA with cadaveric specimens and report our clinical experience for benign JF tumors with predominant extracranial extension. METHODS A stepwise and detailed microsurgical neurovascular anatomy of ALA was explored with cadaveric specimens. Then, the clinical results of 7 consecutive patients who underwent ALA for benign JF tumors with predominant extracranial extension were analyzed. RESULTS A hockey stick skin incision is made along the superior nuchal line to the anterior edge of the sternocleidomastoid muscle (SCM). ALA involves layer-by-layer muscle dissection of SCM, splenius capitis, digastric, longissimus capitis, and superior oblique muscles. The accessory nerve runs beneath SCM and is found at the posterior edge of the digastric muscle. The internal jugular vein (IJV) is lateral to and at the level of the accessory nerve. The occipital artery passes over the longissimus capitis muscle and IJV and into the external carotid artery, which is lateral and superficial to IJV. The internal carotid artery (ICA) is more medial and deeper than external carotid artery and is in the carotid sheath with the vagus nerve and IJV. The hypoglossal and vagus nerves run along the lateral and medial side of ICA, respectively. Prehigh cervical carotid, prejugular, and retrojugular surgical corridors allow deep and extracranial access around JF. In the case series, gross and near-total resections were achieved in 6 (85.7%) patients without newly developed cranial nerve deficits. CONCLUSION ALA is a traditional and invaluable neurosurgical approach for benign JF tumors with predominant extracranial extension. The anatomic knowledge of ALA increases competency in adding anterior and lateral exposure of extracranial JF.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyeong-Cheol Oh
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Paris VII-Diderot University, Paris, France
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
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7
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Zhao P, Zhang Y, Lin F, Kong D, Feng Y, Dai C. Comparison of surgical outcomes between early and advanced class of jugular paragangliomas following application of our modified surgical techniques. Sci Rep 2023; 13:885. [PMID: 36650202 PMCID: PMC9845292 DOI: 10.1038/s41598-023-27821-y] [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] [Received: 02/07/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
To compare the safety and effectiveness of surgical treatment of jugular paragangliomas (JPs) following the application of our modified surgical techniques. Fifty-six patients with JPs were analyzed for tumor classification, surgical outcomes, and intratumor blood vessels. The gross total resection in C1-2 (100%) was significantly greater than that in C3 and D (66.7%). Good postoperative facial nerve (FN) function (House-Brackmann I-II) was achieved in 89.5% C1-2 cases, which was not significantly different from C3 and D (93.3%) (P = 0.694). Preoperative and postoperative lower cranial nerve (LCN) deficits correlated with the Fisch's classification of tumors (P < 0.05), and intraoperative blood loss was greater in advanced tumors (P = 0.050). Further study showed that the cross-sectional area of intratumor blood vessels was positively associated with intraoperative blood loss (P < 0.001). Surgical excision of JPs is a safe and effective strategy, and early surgical treatment is a good option for patients with C1-2 tumors without surgical contraindications.
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Affiliation(s)
- Peng Zhao
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Department of Otolaryngology Head and Neck Surgery, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, China
| | - Yibo Zhang
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China. .,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.
| | - Feng Lin
- Department of Otolaryngology Head and Neck Surgery, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, 353000, China
| | - Dedi Kong
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Yisi Feng
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Chunfu Dai
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China. .,Key Laboratory of Hearing Medicine, Ministry of Health, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.
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Essayed WI, Borba LAB, Al-Mefty O. Simultaneous Endoscopic-Microscopic Skull Base Approach for the Resection of a Dumbbell-Shaped Hypoglossal Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e283. [PMID: 36001476 DOI: 10.1227/ons.0000000000000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis A B Borba
- Department of Neurosurgery, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil.,Department of Neurosurgery, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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9
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Li Q, Yu Y, Zhang L, Liu J, Ren H, Zhen X. Staged Surgery for Intra-Extracranial Communicating Jugular Foramen Paraganglioma: A Case Report and Systematic Review. Brain Sci 2022; 12:brainsci12091257. [PMID: 36138993 PMCID: PMC9496744 DOI: 10.3390/brainsci12091257] [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: 05/25/2022] [Revised: 09/01/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild tinnitus, headache, and dizziness, together with preoperative related imaging, was diagnosed with a left intra-extracranial communicating jugular foramen lesion in November 2015 and accepted an initial operation for the intracranial tumor by retrosigmoid approach. The pathologic report was paraganglioma. In November 2021, a subtotal resection of the extracranial tumor was conducted for prominent lower cranial nerves (LCNs) deficit and middle ear involvement by infratemporal approach. In patients with IECJFP accompanied by LCNs deficit and middle ear involvement, an initial surgery for extracranial lesion and a second procedure for intracranial tumor were appropriate. However, the first operation for the intracranial lesion was preferred in IECJFP cases without LCNs deficit and middle ear involvement, as it could remove compression to the neurovascular structure and brain stem, clarify a pathological diagnosis, avoid a CSF leak, and prevent a severe neurological disorder from extracranial lesion excision. Subtotal resection of the extracranial tumor would be performed when lesion became larger combined with obvious LCNs disorder and tympanic cavity involvement. Consideration of specific staged surgical strategy for IECJFP in accordance with preoperative LCNs deficit and tympanic cavity involvement could prevent critical postoperative neurological deficit and improve quality of life in the long term.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Department of Neurosurgery, Baotou Steel Group Third Staff Hospital, Baotou 014010, China
| | - Yanbing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
- Graduate School of Peking University Health Science Center, Beijing 100191, China
- Correspondence: ; Tel.: +86-185-1931-9666
| | - Li Zhang
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
- Graduate School of Peking University Health Science Center, Beijing 100191, China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
- Graduate School of Capital Medical University, Beijing 100069, China
| | - Hongxiang Ren
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xueke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
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10
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Grinblat G, Sanna M, Piccirillo E, Piras G, Guidi M, Shochat I, Munteanu SG. Comparison of Lower Cranial Nerve Function Between Tympanojugular Paraganglioma Class C1/C2 With and Without Intracranial Extension: A Four-Decade Experience. Otol Neurotol 2022; 43:e122-e130. [PMID: 34889847 DOI: 10.1097/mao.0000000000003383] [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: 11/26/2022]
Abstract
OBJECTIVE To compare preoperative and postoperative lower cranial nerve (LCN) function between Class C1 and C2 tympanojugular paraganglioma (TJP) with/without intracranial intradural (Di)/extradural (De) extensions, according to the experience of a single surgeon over four decades. STUDY DESIGN Retrospective review. SETTING Quaternary referral center for otology and skull base surgery. MATERIAL AND METHODS A chart review was conducted of all the patients operated for C1/C2 TJPs from September 1983 to December 2018. The tumors were classified as: Limited-Group (C1/C2 without Di/De extensions) and Extended-Group (C1/C2 with Di/De extensions). RESULTS Of 159 patients, 107 (67.3%) were women; the mean age at surgery was 46.5 years. The Limited-Group (56.6%) comprised C1 (41.1%) and C2 (58.9%) tumors; the Extended-Group (43.4%) comprised C1+Di/De (14.5%) and C2+Di/De (85.5%) tumors. The prevalence of preoperative LCN palsy was 11.9 times higher in Extended than Limited tumors: 61.9% versus 4.9% (p < 0.05). The risk for postoperative LCN palsy was 4.7 times greater in Extended than Limited tumors: 29.2% versus 12.9%, p = 0.01. CONCLUSION Especially in younger patients, complete removal of Limited C1/C2 tumors, before they extend intracranially, reduces the risk of dysfunctionality of LCNs and the burden of residual tumor. The incidence of new tumors increased over four decades. However, new-postoperative LCN palsy did not occur in any Limited C1/C2 tumors operated after the year 2000, and declined to less than 10% of Extended C1/C2 tumors.
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Affiliation(s)
- Golda Grinblat
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza - Rome, Italy
- Department of ENT, Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mario Sanna
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza - Rome, Italy
| | - Enrico Piccirillo
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza - Rome, Italy
| | - Gianluca Piras
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza - Rome, Italy
| | - Mariapaola Guidi
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza - Rome, Italy
| | - Isaac Shochat
- Department of ENT, Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Simona Gloria Munteanu
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza - Rome, Italy
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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11
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Kadri PAS, Ibn Essayed W, Al-Mefty O. Preservation of Cranial Nerves Function in Glomus Jugulare Surgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e43. [DOI: 10.1227/ons.0000000000000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
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12
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Wu KC, Aboud E, Al-Mefty O. Suprabulbar Approach to Jugular Fossa Tumors: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E524-E525. [PMID: 34670274 DOI: 10.1093/ons/opab339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/02/2021] [Indexed: 11/12/2022] Open
Abstract
Owing to their scarcity, location, and intricate neurovascular associations, jugular fossa tumors are among the most challenging pathologies encountered by the neurosurgeon.1 While paragangliomas originate within and often occlude the jugular bulb, schwannomas and meningiomas are extra-bulbar and typically do not impede venous flow.2 Schwannomas typically arise from an extradural origin, expanding the jugular foramen.3-5 Meningiomas are intradural and cause hyperostosis of the jugular tubercle.6 We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window6 that has been detailed in cadaveric studies.7,8 This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves. The carotid artery can be identified by neuronavigation and micro-Doppler ultrasonography. This approach provides a direct lateral trajectory with a short distance to the jugular fossa and cerebellopontine angle. Early exposure and central debulking of the tumor minimize manipulation of the exquisitely sensitive lower cranial nerves. The distal aspect of these tumors can be removed with endoscopic assisted techniques.9 The first patient is a 49-yr-old woman with a previously irradiated schwannoma who presented with worsening neurologic deficits-an extradural suprabulbar approach was used to resect this tumor. The second patient is a 27-yr-old woman with an enlarging meningioma and associated neurological dysfunction; this tumor was resected using the suprabulbar approach with opening of the presigmoid dura. Both patients have consented to surgery and publication of images. Image at 2:27 and 6:38 reprinted from Arnautović et al, with permission from JNSPG. Image at 2:50 and 6:45 ©Ossama Al-Mefty 1997, reused with permission.
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Affiliation(s)
- Kyle C Wu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA
| | - Emad Aboud
- Department of Neurosurgery, Arkansas Neuroscience Institute, Little Rock, Arkansas, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA
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13
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Colli BO, Junior CGC, de Oliveira RS, Gondim GGP, Abud DG, Massuda ET, de Melo Filho FV, Tanaka K. Surgical management of embolized jugular foramen paragangliomas without facial nerve transposition: Experience of a public tertiary hospital in Brazil. Surg Neurol Int 2021; 12:482. [PMID: 34754532 PMCID: PMC8571183 DOI: 10.25259/sni_651_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Jugular foramen paragangliomas (JFP) treatment represents a challenge for surgeons due to its close relationship with facial nerve (FN), lower cranial nerves (LCN), and internal carotid artery. Due to its hypervascularization, preoperative tumor embolization has been indicated. Methods: Retrospective analysis of the clinical evolution of 26 patients with JFP class C/D previously embolized treated through infratemporal/cervical access without FN transposition. Results: Total and subtotal resections were 50% each, regrowth/recurrence were 25%, and 23%, respectively, and mortality was 3.9%. Postoperatively, 68.4% of patients had FN House and Brackmann (HB) Grades I/II. New FN deficits were 15.4% post embolization and 30.7% postoperatively. Previous FN deficits worsened in 46.1%. Tumor involved the FN in 30.8% and in 62.5% of them these nerves were resected and grafted (60% of them had HB III). Lateral fall, ear murmur, and vertigo improved in all patients. Tinnitus improved in 77.8% and one patient developed tinnitus after surgery. Hearing loss did not improve, eight partial hearing loss remained unchanged and four worsened. New postoperative LCN deficits were 64.3%. Postoperative KPS between 80 and 100 dropped 8.3%. Two patients with secretory paragangliomas with arterial hypertension difficult to control had better postoperative blood pressure control. Conclusion: Although still with significant morbidity due to FN and LCN injuries, the treatment of patients with JFP Fisch C/D has good long-term results. Surgical techniques without FN transposition have less intraoperative nerve damage, lower rates of total resection, and higher recurrence. Preoperative embolization of JFP reduces the intraoperative blood loss but can cause FN deficit.
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Affiliation(s)
- Benedicto Oscar Colli
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carlos Gilberto Carlotti Junior
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Gozzoli Podolski Gondim
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Medical Image, Hematology and Clinical Oncology Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansanti Abud
- Department of Medical Image, Hematology and Clinical Oncology Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Tanaka Massuda
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Veríssimo de Melo Filho
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Koji Tanaka
- Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Yamashita S, Fujita A, Kohta M, Sasayama T, Kohmura E. Bone-destructive osseous arteriovenous fistula at the jugular bulb mimicking a glomus jugular tumor. Neurochirurgie 2021; 68:525-529. [PMID: 34536438 DOI: 10.1016/j.neuchi.2021.09.003] [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: 12/25/2020] [Revised: 06/16/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some reports have described intraosseous arteriovenous fistulas showing osteolytic changes, but an osseous arteriovenous fistula (AVF) at the jugular bulb showing extensive bone destruction is a very rare disease. CASE DESCRIPTION A 60-year-old man presented with pulsatile tinnitus and right facial nerve palsy. Radiological imaging showed a large homogenously enhanced osteolytic lesion at the right jugular foramen. A cerebral angiogram showed a high-flow vascular lesion of the jugular bulb associated with retrograde sinus reflux, resulting in venous congestion of the deep venous system. These findings led us to misdiagnose this lesion as a glomus jugular tumor. However, combined arterial and venous angiography after transarterial embolization revealed the precise angioarchitecture, and we finally diagnosed this lesion as a high-flow osseous AVF at the jugular bulb. We performed transvenous embolization using a triple catheter technique. The lesion was successfully obliterated, and the 6-months angiogram showed no recurrence. CONCLUSION A rare case of high flow osseous AVF at the jugular bulb associated with osteolytic changes in the surrounding bony structure is reported. Although many hypervascular lesions at the jugular bulb are glomus tumors, bone destructive osseous AVF at the jugular bulb should be considered.
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Affiliation(s)
- S Yamashita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - A Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - M Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - T Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - E Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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15
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Ibn Essayed W, Al-Mefty O. Metachronous Skull Base Paraganglioma Surgical Management: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E427-E428. [PMID: 34293168 DOI: 10.1093/ons/opab268] [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: 12/29/2020] [Accepted: 04/04/2021] [Indexed: 11/12/2022] Open
Abstract
Paragangliomas (PGLs) are benign hypervascular tumors that can develop in head and neck at different locations, primarily in the carotid bifurcation, jugular bulb, tympanic plexus, and vagal ganglia.1 Different gene mutations have been linked to the familial inherited forms, which can represent approximately 30% of all PGLs.1,2 These are classified into 5 different clinical syndromes: PGL 1 to 5.1 These patients have increased risk for synchronous and metachronous lesions requiring an extensive work-up for hormone secretion and other associated neoplasms, as well as attentive follow-up for lifelong management.1,3 Surgical resection is the best treatment option as it can be curative when the resection is total.2-4 Preservation of the lower cranial nerve function is central to the management of head and neck PGLs, given the gravity of bilateral injuries.3 Irradiation therapy should be considered if the risk for bilateral lower cranial nerve injuries is high.5 Surgically, intrabulbar resection with preservation of the medial wall of the jugular bulb protects the lower cranial nerve function.3 Other technical finesses, including maintaining the facial nerve in its bony fallopian canal (facial bridge), avoiding carotid artery sacrifice, preservation of the ear canal, and preoperative embolization, contributed markedly to outcome improvement.2,3 We report a case of a 34-yr-old male with PGL 3 with a left glomus jugulare tumor that recurred and a right carotid body tumor. Patient consented to surgery and photography. Image at 3:44 republished from Al-Mefty and Teixeira,3 with permission from JSNPG.
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Affiliation(s)
- Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Weiss NM. Rare Diseases of the Middle Ear and Lateral Skull Base. Laryngorhinootologie 2021; 100:S1-S30. [PMID: 34352901 PMCID: PMC8354576 DOI: 10.1055/a-1347-4171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Otalgia, otorrhea and hearing loss are the most common ear-related symptoms that lead to the consultation of an otolaryngologist. Furthermore, balance disorders and affections of the cranial nerve function may play a role in the consultation. In large academic centres, but also in primary care, the identification of rare diseases of the middle ear and the lateral skull base is essential, as these diseases often require interdisciplinary approaches to establish the correct diagnosis and to initiate safe and adequate treatments. This review provides an overview of rare bone, neoplastic, haematological, autoimmunological and infectious disorders as well as malformations that may manifest in the middle ear and the lateral skull base. Knowledge of rare disorders is an essential factor ensuring the quality of patient care, in particular surgical procedures. Notably, in untypical, complicated, and prolonged disease courses, rare differential diagnoses need to be considered.
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Affiliation(s)
- Nora M. Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie
„Otto Körner“ der Universitätsmedizin Rostock,
Deutschland
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17
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Bhuskute G, Manogaran RS, Keshri A, Mehrotra A, Singh N, Mathialagan A. Surgical Candidacy in Skull Base Paragangliomas: An Institutional Experience. J Neurosci Rural Pract 2020; 12:116-121. [PMID: 33531769 PMCID: PMC7846316 DOI: 10.1055/s-0040-1721201] [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] [Indexed: 11/24/2022] Open
Abstract
Objective
The aim of the study is to determine the surgical candidacy and nuances of skull base paraganglioma surgery in the era of radiotherapy.
Materials and Methods
This was a retrospective observational study conducted in patients who presented with skull base paragangliomas between January 2017 and December 2019. Primary data, including indication for surgery, the approach used, the extent of resection, complications, and postoperative lower cranial nerve status were studied.
Results
A total of 21 cases of skull base paragangliomas were analyzed, including seven cases of tympanic paraganglioma, 10 cases of jugular foramen paraganglioma, three cases of multiple paragangliomas, and one case of vagal paraganglioma. Indications for surgery were young age, bleeding from ear, neck mass with upper aerodigestive pressure symptoms, lower cranial nerve paralysis, and patients with intracranial pressure symptoms. Total excision was done in 11 patients, near-total excision in five patients, subtotal in three patients, and surgery was not done in two patients. Facial nerve paralysis was the most common complication observed, followed by bleeding and flap necrosis. Radiotherapy was considered as adjuvant treatment wherever indicated.
Conclusion
A thorough knowledge and understanding of the pathophysiology of the skull base paragangliomas and its management strategies can help to achieve excellent results in terms of tumor clearance and reduction in complications. A multidisciplinary team approach and meticulous skull base surgical techniques have a significant role to play in the management of paragangliomas, especially in developing countries where availability of radiosurgery is still a challenge.
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Affiliation(s)
- Govind Bhuskute
- Neuro-otology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ravi Sankar Manogaran
- Neuro-otology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Keshri
- Neuro-otology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Neuro-otology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arulalan Mathialagan
- Neuro-otology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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18
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Lozano FS, Muñoz A, de Las Heras JA, González-Porras JR. Simple and complex carotid paragangliomas. Three decades of experience and literature review. Head Neck 2020; 42:3538-3550. [PMID: 32812684 DOI: 10.1002/hed.26421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Carotid paragangliomas are rare tumors. They are usually unique, non-secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. METHODS Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. RESULTS Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow-up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. CONCLUSIONS Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.
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Affiliation(s)
- Francisco S Lozano
- Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Angel Muñoz
- Department of Otorhinolaryngology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José A de Las Heras
- Department of Radiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José R González-Porras
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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19
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Ehret F, Kufeld M, Fürweger C, Haidenberger A, Schichor C, Tonn JC, Muacevic A, Hempel JM. Single-session image-guided robotic radiosurgery and quality of life for glomus jugulare tumors. Head Neck 2020; 42:2421-2430. [PMID: 32394483 DOI: 10.1002/hed.26231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Limited data are available on the efficacy and impact on the quality of life (Qol) of single-session image-guided robotic radiosurgery (RRS) for glomus jugulare tumors (GJTs). This study investigates the role of RRS in the management of GJTs and reviews the RRS literature. METHODS We analyzed 53 GJT patients treated with RRS to evaluate the safety, local control, clinical outcome, and Qol assessed by the SF12v2. RESULTS The local control was 98% at a median follow-up of 38 months. The median tumor volume was 4.3 cc and tumors were treated with a median dose of 16.5 Gy. At the last follow-up, 35 patients had recovered from their symptoms or experienced symptom improvement. Qol analyses showed no significant decline while bodily pain significantly decreased. CONCLUSIONS RRS is a safe and efficient tool for the treatment of GJTs. Qol of patients after treatment is stable and tends to improve over time.
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Affiliation(s)
| | | | - Christoph Fürweger
- European Cyberknife Center, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Christian Schichor
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - John-Martin Hempel
- Department of Otorhinolaryngology and Head and Neck Surgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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20
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Catapano JS, Almefty RO, Ding D, Whiting AC, Pines AR, Richter KR, Ducruet AF, Albuquerque FC. Onyx embolization of skull base paragangliomas: a single-center experience. Acta Neurochir (Wien) 2020; 162:821-829. [PMID: 31919599 DOI: 10.1007/s00701-019-04127-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx. METHODS We retrospectively analyzed data from all patients with skull base paragangliomas who underwent preoperative Onyx embolization at our institution (January 01, 2005-December 31, 2017). Patient, tumor, embolization, and outcomes data were extracted by reviewing inpatient and outpatient clinical and imaging records. RESULTS Seven patients were studied (5/7 [71%] female), 6 with glomus jugulares and 1 with a glomus vagale. The median age was 52 years, and the most common presenting symptom was cranial neuropathy (6/7 [86%]). The tumor vascular supply was from the ascending pharyngeal artery in all 7 cases (100%) with additional feeders including the occipital artery in 5 (71%); internal carotid artery in 3 (43%); middle meningeal, vertebral, and internal maxillary artery each in 2 (29%); and posterior auricular artery in 1 (14%). The median postembolization tumor devascularization was 80% (range, 64-95%). The only postembolization complication was a facial palsy in 1 patient. CONCLUSION Preoperative embolization with Onyx affords excellent devascularization for the majority of skull base paragangliomas, and it may facilitate resection of these hypervascular lesions. The advantages provided by Onyx with respect to penetration of intratumoral vessels must be weighed against the risk of cranial neuropathy.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rami O Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew R Pines
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Kent R Richter
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center c/o Neuroscience Publications, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
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21
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Long-term Outcomes for the Treatment of Paragangliomas in the Upfront, Adjuvant, and Salvage Settings With Stereotactic Radiosurgery and Intensity-modulated Radiotherapy. Otol Neurotol 2020; 41:133-140. [DOI: 10.1097/mao.0000000000002461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Mendez-Rosito D, Guerrero IM, Heredia SR, Ceja DG. Management of a complex glomus jugulare tumor with severe brainstem compression. NEUROSURGICAL FOCUS: VIDEO 2019; 1:V12. [PMID: 36284862 PMCID: PMC9541649 DOI: 10.3171/2019.10.focusvid.19461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/29/2019] [Indexed: 06/16/2023]
Abstract
Surgery of glomus jugulare tumors is complex, but when these tumors have a large intradural component and cause brainstem compression they became a challenge to the surgeon. It is crucial to preoperatively understand the anatomy of the tumor and analyze its relationship with the temporal bone, facial nerve, and foramen jugular neurovascular structures. We present a case of a male patient with a complex glomus jugulare tumor causing severe brainstem compression. Nuances of technique and surgical pearls related to the management of complex jugulare tumors are discussed and illustrated in this operative video. The video can be found here: https://youtu.be/oCjzp0kFRGc.
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Affiliation(s)
| | - Iván Méndez Guerrero
- Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Sergio Reyna Heredia
- Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
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23
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Basma J, Michael LM, Sorenson JM, Robertson JH. Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study. J Neurol Surg B Skull Base 2019; 80:518-526. [PMID: 31534895 DOI: 10.1055/s-0038-1676512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Methods Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Results Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. Conclusion The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Jeffrey M Sorenson
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Jon H Robertson
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
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24
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Boublata L, Ouhab S. Infratemporal approach with anterior transposition of facial nerve in paraganglioma surgery. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Chung SY, Liu JK, Park RC, Jyung RW. Glomus jugulare manifesting as angiogenesis of the external ear canal. EAR, NOSE & THROAT JOURNAL 2018; 96:E39-E40. [PMID: 28346654 DOI: 10.1177/014556131709600324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sei Y Chung
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Sharma M, Meola A, Bellamkonda S, Jia X, Montgomery J, Chao ST, Suh JH, Angelov L, Barnett GH. Long-Term Outcome Following Stereotactic Radiosurgery for Glomus Jugulare Tumors: A Single Institution Experience of 20 Years. Neurosurgery 2018; 83:1007-1014. [PMID: 29228343 DOI: 10.1093/neuros/nyx566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/17/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glomus jugulare tumors (GJTs) are rare benign tumors, which pose significant treatment challenges due to proximity to critical structures. OBJECTIVE To evaluate the long-term clinical and radiological outcome in patients undergoing stereotactic radiosurgery (SRS) for GJTs through retrospective study. METHODS Forty-two patients with 43 GJTs were treated using Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) at our institute from 1997 to 2016. Clinical, imaging, and radiosurgery data were collected from an institutional review board approved database. RESULTS Most patients were females (n = 35, 83.3%) and median age was 61 yr (range 23-88 yr). Median tumor volume and diameter were 5 cc and 3 cm, respectively, with a median follow-up of 62.3 mo (3.4-218.6 mo). Overall, 20 patients (47.6%) improved clinically and 14 (33.3%) remained unchanged at last follow-up. New onset or worsening of hearing loss was noted in 6 patients (17.2%) after SRS. The median prescription dose to the tumor margin was 15 Gy (12-18 Gy). Median reduction in tumor volume and maximum tumor diameter at last follow-up was 33.3% and 11.54%, respectively. The 5-yr and 10-yr tumor control rates were 87% ± 6% and 69% ± 13%, respectively. There was no correlation between maximum or mean dose to the internal acoustic canal and post-GK hearing loss (P > .05). CONCLUSION SRS is safe and effective in patients with GJTs and results in durable, long-term control. SRS has lower morbidity than that associated with surgical resection, particularly lower cranial nerve dysfunction, and can be a first-line management option in these patients.
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Affiliation(s)
- Mayur Sharma
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Antonio Meola
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sushma Bellamkonda
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Xuefei Jia
- Department of Biostatistics, Cleveland Clinic, Cleveland, Ohio
| | - Joshua Montgomery
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samuel T Chao
- Cleveland Clinic Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - John H Suh
- Cleveland Clinic Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Lilyana Angelov
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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de Brito R, Cisneros Lesser JC, Lopes PT, Bento RF. Preservation of the facial and lower cranial nerves in glomus jugulare tumor surgery: modifying our surgical technique for improved outcomes. Eur Arch Otorhinolaryngol 2018; 275:1963-1969. [PMID: 29858925 DOI: 10.1007/s00405-018-5026-0] [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: 03/06/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To describe the neurological results obtained in six patients with large Fisch C glomus jugulare tumors (GJT) in which a less aggressive, nerve-preserving surgical strategy was used to reduce surgical morbidity. METHODS Prospective study of six patients with Fisch C GJT who underwent surgery in a tertiary care referral center from February 2015 to August 2017 with an average follow-up of 18 months. The intervention is the surgical technique used and the main outcome measures are recurrence and the functional preservation of the facial and lower cranial nerves. RESULTS Gross total removal was obtained in the six patients with preservation of the medial wall of the jugular bulb protecting the lower cranial nerves. After follow-up, we obtained a House-Brackmann (H-B) grade II in three patients who were managed with an inferior facial nerve transposition. One patient managed with a facial bridge technique preserved a normal facial function and two patients who presented a H-B III before surgery went to H-B V after surgery and recovered to a H-B III after 4 months. Four patients were presented with dysphagia after surgery and required nasogastric tube placement. The average time for removal with return to normal oral feeding was 4.3 weeks. Three patients with preoperative Xth nerve dysfunction showed an adequate compensation of the opposite vocal fold in the postoperative period without dysphonia or aspiration. CONCLUSION The surgical techniques used in these patients provided good functional preservation without recurrence after an 8-30-month follow-up.
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Affiliation(s)
- Rubens de Brito
- Otorhinolaryngology and Neurotology, Health Science, Hospital das Clínicas, Otorhinolaryngology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 6th floor, room 6167, São Paulo, 05403-000, Brazil
| | - Juan Carlos Cisneros Lesser
- Otorhinolaryngology and Neurotology, Health Science, Hospital das Clínicas, Otorhinolaryngology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 6th floor, room 6167, São Paulo, 05403-000, Brazil. .,National Institute of Rehabilitation, Mexico City, Mexico.
| | - Paula Tardim Lopes
- Otorhinolaryngology and Neurotology, Health Science, Hospital das Clínicas, Otorhinolaryngology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 6th floor, room 6167, São Paulo, 05403-000, Brazil
| | - Ricardo Ferreira Bento
- Otorhinolaryngology and Neurotology, Health Science, Hospital das Clínicas, Otorhinolaryngology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 6th floor, room 6167, São Paulo, 05403-000, Brazil
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Sallabanda K, Barrientos H, Isernia Romero DA, Vargas C, Gutierrez Diaz JA, Peraza C, Rivin Del Campo E, Praena-Fernandez JM, López-Guerra JL. Long-term outcomes after radiosurgery for glomus jugulare tumors. TUMORI JOURNAL 2018; 104:300-306. [PMID: 29714667 DOI: 10.1177/0300891618765576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS AND BACKGROUND The treatment of glomus jugulare tumors (GJT) remains controversial due to high morbidity. Historically, these tumors have primarily been managed surgically. The purpose of this retrospective review was to assess the tumor and clinical control rates as well as long-term toxicity of GJT treated with radiosurgery. METHODS Between 1993 and 2014, 30 patients with GJT (31 tumors) were managed with radiosurgery. Twenty-one patients were female and the median age was 59 years. Twenty-eight patients (93%) were treated with radiosurgery, typically at 14 Gy ( n = 26), and 2 patients (7%) with stereotactic radiosurgery. Sixteen cases (52%) had undergone prior surgery. RESULTS The mean follow-up was 4.6 years (range 1.5-12). Crude overall survival, tumor control, clinical control, and long-term grade 1 toxicity rates were 97%, 97%, 97%, and 13% (4/30), respectively. No statistically significant risk factor was associated with lower tumor control in our series. Univariate analysis showed a statistically significant association between patients having 1 cranial nerve (CN) involvement before radiosurgery and a higher risk of lack of improvement of symptoms (odds ratio 5.24, 95% confidence interval 1.06-25.97, p = .043). CONCLUSIONS Radiosurgery is an effective and safe treatment modality for GJT. Patients having 1 CN involvement before radiosurgery show a higher risk of lack of improvement of symptoms.
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Affiliation(s)
- Kita Sallabanda
- 1 Department of Surgery, Complutense University, Madrid, Spain.,2 Department of Neurosurgery, GenesisCare, Madrid, Spain
| | - Hernan Barrientos
- 3 Department of Neurosurgery, Instituto Neurológico de Colombia, Medellín, Colombia
| | - Daniela Angelina Isernia Romero
- 4 Máster Internacional en Aplicaciones Tecnológicas Avanzadas en Oncología Radioterápica de la Universidad de Murcia, GenesisCare Fundación, Madrid, Spain
| | - Cristian Vargas
- 5 Department of Epidemiology, Instituto Neurológico de Colombia, Medellín, Colombia
| | | | - Carmen Peraza
- 6 Department of Radiation Physics, GenesisCare, Madrid, Spain
| | | | | | - José Luis López-Guerra
- 9 Department of Radiation Oncology, University Hospital Virgen del Rocio, Seville, Spain
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Abstract
Background: Jugulotympanic paraganglioma (JTP) are benign, high-vascularized lesions that frequently invade the jugular foramen, temporal bone, the upper neck, and the posterior fossa cavity, resulting in a wide variety of clinical symptoms. Methods: In this retrospective study, we assess the clinical symptoms and discuss the individual multidisciplinary treatment and outcome of 22 patients with JTP. Results: In 12 patients, a hearing deficit was the presenting symptom, whereas pulsatile tinnitus and otalgia were present in six and four patients respectively. Facial nerve involvement was seen in six patients (three HB Grade 1–2 and three HB Grade 4–6). Four patients presented with lower cranial nerve impairment. Rare symptoms were ataxia caused by brainstem compression and papilledema due to cerebral sinus obstruction. A new or worsening of the preoperative facial nerve or lower cranial nerve function occurred in two and four patients respectively. Conclusion: The treatment strategy and the surgical approach for JTP should be tailored to the tumor extension and the patient’s clinical symptoms.
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Hafez RFA, Morgan MS, Fahmy OM, Hassan HT. Long-term effectiveness and safety of stereotactic gamma knife surgery as a primary sole treatment in the management of glomus jagulare tumor. Clin Neurol Neurosurg 2018. [PMID: 29514114 DOI: 10.1016/j.clineuro.2018.02.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study aims to report and confirm long-term effectiveness and safety of stereotactic Gamma Knife Surgery as a primary sole treatment in the management of 40 glomus jagulare tumors patients. PATIENTS AND METHODS Retrospective analysis of clinical and radiological outcomes of 40 GJTs consecutive patients treated with GKS as primary sole treatment at International Medical Center (IMC), Cairo-Egypt from the beginning of 2005 till the end of 2014,with mean follow-up period of 84 months (range 36-156 months), mean tumor volume was 6.5 cc, and mean peripheral radiation dose of 15 Gy, to mean isodose curve of 38%. RESULTS The most common neurological deficit at initial evaluation was bulbar symptoms in 24 patients, followed by pulsatile tinnitus in 22, deterioration of hearing in 20 patients. The overall clinical control achieved in 92.5% of patients, while actuarial tumor size control rate post- GKS was 97.5% at 3 years, 97% at 5 years and 92% at 10 years of follow-up period. CONCLUSIONS Gamma knife surgery could be used effectively and safely as a primary sole treatment tool in the management of glomus jugulare tumors.
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Affiliation(s)
- Raef F A Hafez
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
| | - Magad S Morgan
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
| | - Osama M Fahmy
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
| | - Hamdy T Hassan
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
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Fennell VS, Martirosyan NL, Atwal GS, Kalani MYS, Ponce FA, Lemole GM, Dumont TM, Spetzler RF. Hemodynamics Associated With Intracerebral Arteriovenous Malformations: The Effects of Treatment Modalities. Neurosurgery 2017; 83:611-621. [DOI: 10.1093/neuros/nyx560] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022] Open
Abstract
Abstract
The understanding of the physiology of cerebral arteriovenous malformations (AVMs) continues to expand. Knowledge of the hemodynamics of blood flow associated with AVMs is also progressing as imaging and treatment modalities advance. The authors present a comprehensive literature review that reveals the physical hemodynamics of AVMs, and the effect that various treatment modalities have on AVM hemodynamics and the surrounding cortex and vasculature. The authors discuss feeding arteries, flow through the nidus, venous outflow, and the relative effects of radiosurgical monotherapy, endovascular embolization alone, and combined microsurgical treatments. The hemodynamics associated with intracranial AVMs is complex and likely changes over time with changes in the physical morphology and angioarchitecture of the lesions. Hemodynamic change may be even more of a factor as it pertains to the vast array of single and multimodal treatment options available. An understanding of AVM hemodynamics associated with differing treatment modalities can affect treatment strategies and should be considered for optimal clinical outcomes.
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Affiliation(s)
- Vernard S Fennell
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nikolay L Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- Division of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Gursant S Atwal
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - G Michael Lemole
- Division of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Travis M Dumont
- Division of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Abstract
OBJECTIVE Determine treatment outcomes of stereotactic radiosurgery (SRS) for glomus jugulare tumors (GJT), focusing on three-dimensional volume change and symptoms before and after SRS, as well as complications related to SRS. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Thirty-eight patients treated with SRS between 2000 and 2015. INTERVENTION SRS treatment of GJT. MAIN OUTCOME MEASURES The tumor volumes on pre- and posttreatment imaging were compared utilizing the Leskell GammaPlan treatment plan software to assess tumor progression. Pre- and posttreatment symptoms, Fisch classification, and complications were recorded. RESULTS The mean radiographic follow-up was 39.1 months. The mean dose-to-tumor margin was 13.2 Gy. The mean tumor size at treatment was 5.8 and 5.2 cm at last follow-up. Thirty-three patients had follow-up imaging suitable for analysis. When defining both 10 and 15% tumor size increases as significant, 27 (82%) and 29 (88%) tumors decreased in size or remained stable, respectively. For the seven tumors with documented pre-SRS growth, treatment success was 86%. The mean marginal dose for treatment success and failure were 13.2 and 13.7 Gy, respectively. Patients receiving a higher margin dose had a greater risk of tumor progression (p = 0.0277). Fisch classification did not impact tumor progression rate. Initial tumor volume had no significance on tumor response to SRS. CONCLUSIONS SRS is an effective treatment option for GJT. Both initial tumor volume and Fisch classification did not impact tumor progression. There were no significant patient or lesion characteristics that distinguished treatment success and/or failure.
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Wakefield DV, Venable GT, VanderWalde NA, Michael LM, Sorenson JM, Robertson JH, Cunninghan D, Ballo MT. Comparative Neurologic Outcomes of Salvage and Definitive Gamma Knife Radiosurgery for Glomus Jugulare: A 20-Year Experience. J Neurol Surg B Skull Base 2017; 78:251-255. [PMID: 28593112 DOI: 10.1055/s-0036-1597986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022] Open
Abstract
Objective This case series investigates management of glomus jugulare (GJ) tumors utilizing definitive and salvage Gamma Knife stereotactic radiosurgery (GKSRS). Methods A retrospective chart review was performed to collect data. Statistical analysis included patient, tumor, and treatment information. Results From 1996 to 2013, 17 patients with GJ received GKSRS. Median age was 64 years (range, 27-76). GKSRS was delivered for definitive treatment in eight (47%) and salvage in nine (53%) patients. Median tumor volume was 9.8 cm 3 (range, 2.8-42 cm 3 ). Median dose was 15 Gy (range, 13-18 Gy). Median follow-up was 123 months (range, 38-238 months). Tumor size decreased in 10 (59%), stabilized in 6 (35%), and increased in 1 patient (6%). Overall neurological deficit improved in 53%, stabilized in 41%, and worsened in 6% of patients. Overall cause-specific survival was 100%, and actuarial local control was 94%. Eighty-eight percent of patients without prior resection experienced neurologic deficit improvement, while 25% of patients with prior resection experienced neurologic improvement ( p = 0.02). Conclusion Gamma Knife radiosurgery provides effective long-term control of GJ and overall improvement or stabilization of neurological deficit in most patients. Patients with prior resection are less likely to experience improvement of neurologic deficit.
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Affiliation(s)
- Daniel V Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,West Cancer Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Jeffery M Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Jon H Robertson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - David Cunninghan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Matthew T Ballo
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,West Cancer Center, Memphis, Tennessee, United States
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Marchetti M, Pinzi V, Tramacere I, Bianchi LC, Ghielmetti F, Fariselli L. Radiosurgery for Paragangliomas of the Head and Neck: Another Step for the Validation of a Treatment Paradigm. World Neurosurg 2016; 98:281-287. [PMID: 27825903 DOI: 10.1016/j.wneu.2016.10.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Paragangliomas are highly vascular and predominantly benign neoplasms that traditionally have been treated by surgery, embolization, and/or external beam radiotherapy. The aim of this study was to evaluate long-term local tumor control and the safety of radiosurgery for head and neck paragangliomas. METHODS Data were obtained from prospectively maintained databases of patients affected by brain tumors treated with radiosurgery at our institution. The inclusion criteria were histologically proven or radiologic-suspected diagnosis of paragangliomas; a follow-up period of at least 12 months, an magnetic resonance imaging-based tumor growth control analysis and a signed written consent. Twenty patients (21 paragangliomas) met the eligibility criteria and were included in the present study. All patients were clinically and radiologically evaluated before and after treatment. RESULTS The mean follow-up at the time of the present analysis was 46 months. Seven patients had a follow-up longer than 60 months. Seven lesions underwent a single-session radiosurgery with a mean dose of 12.2 Gy (range 11-13 Gy). Fourteen lesions underwent multisession radiosurgery with a mean dose of 25.7 Gy (range 20-30 Gy) delivered in 3-5 fractions. The mean tumor volume for single-session radiosurgery was 4 cc (range 1.4-9.2). The mean volume for multisession radiosurgery was 18.9 cc (range 1.3-50.9). None of the lesions showed progression on radiology during the follow-up period. Neurologic conditions generally are maintained or improved. CONCLUSIONS Both single and multisession radiosurgery were confirmed as a safe and effective treatment modality for paragangliomas. Multisession radiosurgery appears effective to treat large lesions.
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Affiliation(s)
- Marcello Marchetti
- Radiotherapy Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
| | - Valentina Pinzi
- Radiotherapy Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Irene Tramacere
- Neuroepidemiology Unit, Health Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | | | - Laura Fariselli
- Radiotherapy Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
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Ibrahim R, Ammori MB, Yianni J, Grainger A, Rowe J, Radatz M. Gamma Knife radiosurgery for glomus jugulare tumors: a single-center series of 75 cases. J Neurosurg 2016; 126:1488-1497. [PMID: 27392265 DOI: 10.3171/2016.4.jns152667] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Glomus jugulare tumors are rare indolent tumors that frequently involve the lower cranial nerves (CNs). Complete resection can be difficult and associated with lower CN injury. Gamma Knife radiosurgery (GKRS) has established its role as a noninvasive alternative treatment option for these often formidable lesions. The authors aimed to review their experience at the National Centre for Stereotactic Radiosurgery, Sheffield, United Kingdom, specifically the long-term tumor control rate and complications of GKRS for these lesions. METHODS Clinical and radiological data were retrospectively reviewed for patients treated between March 1994 and December 2010. Data were available for 75 patients harboring 76 tumors. The tumors in 3 patients were treated in 2 stages. Familial and/or hereditary history was noted in 12 patients, 2 of whom had catecholamine-secreting and/or active tumors. Gamma Knife radiosurgery was the primary treatment modality in 47 patients (63%). The median age at the time of treatment was 55 years. The median tumor volume was 7 cm3, and the median radiosurgical dose to the tumor margin was 18 Gy (range 12-25 Gy). The median duration of radiological follow-up was 51.5 months (range 12-230 months), and the median clinical follow-up was 38.5 months (range 6-223 months). RESULTS The overall tumor control rate was 93.4% with low CN morbidity. Improvement of preexisting deficits was noted in 15 patients (20%). A stationary clinical course and no progression of symptoms were noted in 48 patients (64%). Twelve patients (16%) had new symptoms or progression of their preexisting symptoms. The Kaplan-Meier actuarial tumor control rate was 92.2% at 5 years and 86.3% at 10 years. CONCLUSIONS Gamma Knife radiosurgery offers a risk-versus-benefit treatment option with very low CN morbidity and stable long-term results.
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Affiliation(s)
- Ramez Ibrahim
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | | | - John Yianni
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | - Alison Grainger
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | - Jeremy Rowe
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | - Matthias Radatz
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
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Rangel-Castilla L, Russin JJ, Spetzler RF. Surgical management of skull base tumors. Rep Pract Oncol Radiother 2016; 21:325-35. [PMID: 27330418 PMCID: PMC4899518 DOI: 10.1016/j.rpor.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/21/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
AIM To present a review of the contemporary surgical management of skull base tumors. BACKGROUND Over the last two decades, the treatment of skull base tumors has evolved from observation, to partial resection combined with other therapy modalities, to gross total resection and no adjuvant treatment with good surgical results and excellent clinical outcomes. MATERIALS AND METHODS The literature review of current surgical strategies and management of skull base tumors was performed and complemented with the experience of Barrow Neurological Institute. RESULTS Skull base tumors include meningiomas, pituitary tumors, sellar/parasellar tumors, vestibular and trigeminal schwannomas, esthesioneuroblastomas, chordomas, chondrosarcomas, and metastases. Surgical approaches include the modified orbitozygomatic, pterional, middle fossa, retrosigmoid, far lateral craniotomy, midline suboccipital craniotomy, and a combination of these approaches. The selection of an appropriate surgical approach depends on the characteristics of the patient and the tumor, as well as the experience of the neurosurgeon. CONCLUSION Modern microsurgical techniques, diagnostic imaging, intraoperative neuronavigation, and endoscopic technology have remarkably changed the concept of skull base surgery. These refinements have extended the boundaries of tumor resection with minimal morbidity.
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Affiliation(s)
| | | | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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37
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Jaiswal M, Bhaskar MK, Mittal RS, Ojha B. Positional hoarseness: an unusual symptom in jugular foramen mass. BMJ Case Rep 2016; 2016:bcr-2016-215805. [PMID: 27190124 DOI: 10.1136/bcr-2016-215805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We came across a case of jugular foramen mass causing positional hoarseness on turning the head left and disappearing on returning the head to a straight position. Hoarseness of voice due to vagus nerve involvement is seen in jugular foramen mass but positional hoarseness has never been seen before. We report this rarest presentation and discuss the pathophysiology behind it.
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Affiliation(s)
- Manish Jaiswal
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mukesh Kumar Bhaskar
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Balkrishna Ojha
- Department of Neurosurgery, CSM Medical University, Lucknow, Uttar Pradesh, India
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Scerrati A, Ercan S, Wu P, Zhang J, Ammirati M. Intrapetrous Internal Carotid Artery: Evaluation of Exposure, Mobilization and Surgical Maneuvers Feasibility from a Retrosigmoid Approach in a Cadaveric Model. World Neurosurg 2016; 91:443-50. [PMID: 27126909 DOI: 10.1016/j.wneu.2016.04.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To provide a quantification of the exposure of the vertical and horizontal segments of the intrapetrous carotid artery (IPCA) and to evaluate the possibilities of its mobilization and of performing surgical maneuvers on it using the retrosigmoid approach. METHODS Twelve surgical dissections were performed bilaterally on 6 fresh cadavers. Predissection computed tomography (CT) scans with bone fiducials for intraoperative navigation were acquired. A retrosigmoid craniectomy was performed. The inframeatal space was drilled, the horizontal (HoIPCA) and vertical (VeIPCA) segments of the IPCA were exposed, and their measurements were recorded. The carotid canal was enlarged, the artery was carefully detached from the bone, and a vessel loop was inserted in order to mobilize its horizontal segment. Afterwards we performed different surgical maneuvers: We inflated a 5-French Fogarty balloon to compress the IPCA and repaired a 7-mm arteriotomy with a running suture. Specimens underwent a new CT scan to evaluate the amount of bone removal and the integrity of the inner ear structures. RESULTS The HoIPCA and VeIPCA were exposed and anatomically preserved in all specimens without injuring the surrounding neurovascular structures. The HoIPCA presented an average length of 24.89 mm (range: 19.41-31.47 mm), and the VeIPCA presented an average length of 10.07 mm (range: 8.92-11.58 mm). The possibility of IPCA mobilization and the feasibility of performing surgical maneuvers were demonstrated. Postdissection CT scan showed the preservation of inner ear structures. CONCLUSION Exposure and mobilization of the IPCA using a retrosigmoid approach are feasible and could represent a viable option for the possibility of reaching a total resection of selected skull base tumors, even when involvement of the carotid canal is present.
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Affiliation(s)
- Alba Scerrati
- Institute of Neurosurgery, Catholic University of Rome, Rome, Italy; Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Serdar Ercan
- Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Pengfei Wu
- Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Neurosurgery, the First Affiliated Hospital, China Medical University Heping District, Shenyang City, Liaoning Province, China
| | - Jun Zhang
- Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Mario Ammirati
- Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
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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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Hafez RFA, Morgan MS, Fahmy OM. An intermediate term benefits and complications of gamma knife surgery in management of glomus jugulare tumor. World J Surg Oncol 2016; 14:36. [PMID: 26879488 PMCID: PMC4753653 DOI: 10.1186/s12957-016-0779-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 01/26/2016] [Indexed: 11/03/2022] Open
Abstract
Glomus tumors are rare skull base slow-growing, hypervascular neoplasms that frequently involve critical neurovascular structures, and delay in diagnosis is frequent. Surgical removal is rarely radical and is usually associated with morbidity or mortality. Gamma knife surgery (GKS) has gained an increasing dependable role in the management of glomus jugulare tumors, with high rate of tumor growth control, preserving or improving clinical status and with limited complications. This study aims to evaluate intermediate term benefits and complications of gamma knife surgery in management of twenty-two patients bearing growing glomus jugulare tumors at the International Medical Center (IMC), Cairo, Egypt, between 2005 and 2011. The mean follow-up period was 56 months (range 36-108 months); there were 3 males, 19 females; mean age was 43.6 years; 15 patients had GKS as the primary treatment; 2 patients had surgical residuals; 2 had previous radiation therapy; and 3 previously underwent endovascular embolization. The average tumor volume was 7.26 cm3, and the mean marginal dose was 14.7 Gy. Post gamma knife surgery through the follow-up period neurological status was improved in 12 patients, 7 showed stable clinical condition and 3 patients developed new moderate deficits. Tumor volume post GKS was unchanged in 13 patients, decreased in 8, and showed tumor regrowth in 1 patient. Tumor progression-free survival in our studied patients was 95.5% at 5 and 7 years of the follow-up period post GKS. Gamma knife surgery could be used safely and effectively with limited complications as a primary management tool in the treatment of glomus jugulare tumors controlling tumor growth with preserving or improving clinical status especially those who do not have significant cranial or cervical extension, elderly, and surgically unfit patients; moreover, it is safe and highly effective as adjuvant therapy as well.
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Affiliation(s)
- Raef F A Hafez
- Department of Neurosurgery and Gamma Knife center, International Medical Center (IMC), Cairo, Egypt.
| | - Magad S Morgan
- Department of Neurosurgery and Gamma Knife center, International Medical Center (IMC), Cairo, Egypt
| | - Osama M Fahmy
- Department of Neurosurgery and Gamma Knife center, International Medical Center (IMC), Cairo, Egypt
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Bacciu A, Prasad SC, Sist N, Rossi G, Piazza P, Sanna M. Management of the cervico-petrous internal carotid artery in class C tympanojugular paragangliomas. Head Neck 2015; 38:899-905. [PMID: 26614405 DOI: 10.1002/hed.24284] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/07/2015] [Accepted: 09/13/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Management of the cervical and petrous internal carotid artery (ICA) is frequently required in Fisch class C tympanojugular paragangliomas (TJPs). The purpose of this study was to discuss the perioperative intervention of the ICA in patients who underwent surgical resection of a TJP. METHODS A retrospective study of 237 patients surgically treated for Fisch class C TJPs was done to identify cases that required ICA management. RESULTS Management of the ICA was required in 176 patients (74.2%). Forty-two patients required just an ICA decompression, 88 underwent a subperiosteal dissection, 19 underwent subadventitial dissection without intraluminal stenting, 17 underwent subadventitial dissection with intraluminal stenting, and 12 underwent arterial resection after permanent balloon occlusion. There were no complications associated with the endovascular procedures. Gross total tumor resection was achieved in 91.5% of the cases. CONCLUSION Preoperative endovascular intervention, in selected cases, facilitates gross total tumor removal and significantly reduces the risk of an intraoperative ICA injury. © 2015 Wiley Periodicals, Inc. Head Neck 38: 899-905, 2016.
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Affiliation(s)
- Andrea Bacciu
- Department of Clinical and Experimental Medicine, Otolaryngology Unit, University-Hospital of Parma, Parma, Italy
| | | | - Natalie Sist
- Department of Otolaryngology, Eastern Health, Box Hill, Victoria, Australia
| | - Giulia Rossi
- Department of Clinical and Experimental Medicine, Otolaryngology Unit, University-Hospital of Parma, Parma, Italy
| | - Paolo Piazza
- Department of Neuroradiology, University-Hospital of Parma, Parma, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
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Prasad SC, Mimoune HA, Khardaly M, Piazza P, Russo A, Sanna M. Strategies and long-term outcomes in the surgical management of tympanojugular paragangliomas. Head Neck 2015; 38:871-85. [PMID: 26343411 DOI: 10.1002/hed.24177] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to share our review of surgical strategies and long-term outcomes in the management of tympanojugular paragangliomas. METHODS This was a retrospective study with a literature review. The records of 184 patients with 185 tympanojugular paragangliomas were analyzed for tumor class, surgical procedure, preoperative vascular management, and perioperative sequelae. RESULTS Of class C1, C2, C3, and C4 tumors, we found 46 (24.9%), 95 (51.3%), 41 (22.2%), and 3 (1.6%), respectively. One hundred four (56.2%) tumors had intracranial extensions and 8 (4.3%) involved the vertebral artery. A single-stage procedure was adopted in 158 (85.4%) tumors. The infratemporal fossa type A approach was used in all cases. In 17 patients (9.7%), an intra-arterial stenting of the internal carotid artery was performed. Gross-total tumor removal was achieved in 166 cases (89.7%) and 4 (2.4%) among them developed a recurrence. CONCLUSION A thorough understanding of skull base techniques and a logical decision-making process in the management of tympanojugular paragangliomas can achieve a high rate of success in terms of recurrences and complications. © 2015 Wiley Periodicals, Inc. Head Neck 38: 871-885, 2016.
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Affiliation(s)
| | - Hassen Ait Mimoune
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mohsen Khardaly
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.,King Fahad Central Hospital, Jizan, Kingdom of Saudi Arabia
| | - Paolo Piazza
- Department of Radiology, University of Parma, Parma, Italy
| | - Alessandra Russo
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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El Majdoub F, Hunsche S, Igressa A, Kocher M, Sturm V, Maarouf M. Stereotactic LINAC-Radiosurgery for Glomus Jugulare Tumors: A Long-Term Follow-Up of 27 Patients. PLoS One 2015; 10:e0129057. [PMID: 26069957 PMCID: PMC4466539 DOI: 10.1371/journal.pone.0129057] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/04/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The optimal treatment of glomus jugulare tumors (GJTs) remains controversial. Due to the critical location, microsurgery still provides high treatment-related morbidity and a decreased quality of life. Thus, we performed stereotactical radiosurgery (SRS) for the treatment of GJTs and evaluated the long-term outcome. METHODS Between 1991 and 2011, 32 patients with GJTs underwent SRS using a linear accelerator (LINAC) either as primary or salvage therapy. Twenty-seven patients (median age 59.9 years, range 28.7-79.9 years) with a follow-up greater than five years (median 11 years, range 5.3-22.1 years) were selected for retrospective analysis. The median therapeutic single dose applied to the tumor surface was 15 Gy (range 11-20 Gy) and the median tumor volume was 9.5 ml (range 2.8-51 ml). RESULTS Following LINAC-SRS, 10 of 27 patients showed a significant improvement of their previous neurological complaints, whereas 12 patients remained unchanged. Five patients died during follow-up due to old age or other, not treatment-related reasons. MR-imaging showed a partial remission in 12 and a stable disease in 15 patients. No tumor progression was observed. The actuarial overall survival rates after five, ten and 20 years were 100%, 95.2% and 79.4%, respectively. CONCLUSIONS Stereotactic LINAC-Radiosurgery can achieve an excellent long-term tumor control beside a low rate of morbidity in the treatment of GJTs. It should be considered as an alternative therapy regime to surgical resection or fractionated external beam radiation either as primary, adjuvant or salvage therapy.
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Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Stereotaxy and Functional Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
- * E-mail:
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Stereotaxy and Functional Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
| | - Alhadi Igressa
- Department of Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
| | - Martin Kocher
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Neurosurgery, University Hospital of Wurzburg, Wurzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
- Department of Stereotaxy and Functional Neurosurgery, University of Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
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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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Ioannides PJ, Hansen TM, McDonald MW. Proton and X-ray Radiation for Head and Neck Paragangliomas. Int J Part Ther 2015. [DOI: 10.14338/ijpt-14-00023.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Harati A, Deitmer T, Rohde S, Ranft A, Weber W, Schultheiß R. Microsurgical treatment of large and giant tympanojugular paragangliomas. Surg Neurol Int 2014; 5:179. [PMID: 25593763 PMCID: PMC4287915 DOI: 10.4103/2152-7806.146833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/13/2014] [Indexed: 11/09/2022] Open
Abstract
Background: Tympanojugular paragangliomas (TJPs) are benign, highly vascularized lesions located in the jugular foramen with frequent invasion to the temporal bone, the upper neck, and the posterior fossa cavity. Their natural history, surgical treatment, and outcome have been well addressed in the recent literature; however, there is no consensus regarding the optimal management while minimizing treatment-related morbidity. In this study, we assessed the interdisciplinary microsurgical treatment and outcome of large TJP collected at a single center. Methods: Out of 54 patients with skull base paraganglioma, 14 (25%) presented with large TJP (Fisch grade C and D). Posterior fossa involvement was present in 10 patients (Fisch D). Eleven patients presented with hearing loss, two patients with mild facial nerve palsy, and two patients with lower cranial nerve deficits. Two other patients with previous surgery presented with tumor regrowth. Results: Preoperative embolization was performed in 13 cases. Radical tumor removal was possible in 10 patients. Hearing was preserved in four patients with normal preoperative audiogram. The facial nerve was preserved in all patients. Temporary facial nerve palsy occurred in two patients and resolved in long-term follow-up. In three patients, preexisting facial nerve palsy remained unchanged. Persistent vocal cord palsy was present in three patients and was treated with laryngoplasty. The global recovery based on the Karnofsky performance scale was 100% in 10 patients and 90% in 4 patients. Conclusion: Preoperative embolization and interdisciplinary microsurgical resection are the preferred treatment for selected patients due to high tumor control rates and good long-term results.
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Affiliation(s)
- Ali Harati
- Department of Neurosurgery, Klinikum Dortmund, Münsterstrasse 241, Germany
| | - Thomas Deitmer
- Department for Head and Neck Surgery, Klinikum Dortmund, Beurhausstrasse 40, Dortmund, Germany
| | - Stefan Rohde
- Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, Dortmund, Germany
| | - Alexander Ranft
- Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, Dortmund, Germany
| | - Werner Weber
- Department of Radiology and Neuroradiology, Knappschaftskrankenhaus Bochum Langendreer, Ruhr-University Bochum, Germany
| | - Rolf Schultheiß
- Department of Neurosurgery, Klinikum Dortmund, Münsterstrasse 241, Germany
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Taïeb D, Kaliski A, Boedeker CC, Martucci V, Fojo T, Adler JR, Pacak K. Current approaches and recent developments in the management of head and neck paragangliomas. Endocr Rev 2014; 35:795-819. [PMID: 25033281 PMCID: PMC4167435 DOI: 10.1210/er.2014-1026] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors belonging to the family of pheochromocytoma/paraganglioma neoplasms. Despite advances in understanding the pathogenesis of these tumors, the growth potential and clinical outcome of individual cases remains largely unpredictable. Over several decades, surgical resection has long been the treatment of choice for HNPGLs. However, increasing experience in various forms of radiosurgery has been reported to result in curative-like outcomes, even for tumors localized in the most inaccessible anatomical areas. The emergence of such new therapies challenges the traditional paradigm for the management of HNPGLs. This review will assist and guide physicians who encounter patients with such tumors, either from a diagnostic or therapeutic standpoint. This review will also particularly emphasize current and emerging knowledge in genetics, imaging, and therapeutic options as well as the health-related quality of life for patients with HNPGLs.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine (D.T.), La Timone University Hospital, CERIMED, Aix-Marseille Univ, F-13385 Marseille, France; Department of Radiation Oncology (A.K.), Besançon University Hospital, F-25030 Besançon, France; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), HELIOS Hanseklinikum Stralsund, D-18435 Stralsund, Germany; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), University Hospital, Freiburg, Germany; Program in Reproductive and Adult Endocrinology (V.M., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development and Medical Oncology Branch (T.F.), National Institutes of Health, Bethesda, Maryland 20892; Department of Neurosurgery (J.R.A.), Stanford Hospital and Clinics, Stanford University, Stanford, California 94305
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Teranishi Y, Kohno M, Sora S, Sato H, Haruyama N. Perioperative management of catecholamine-secreting glomus jugulare tumors. J Neurol Surg Rep 2014; 75:e170-4. [PMID: 25083379 PMCID: PMC4110135 DOI: 10.1055/s-0034-1378154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 04/13/2014] [Indexed: 11/12/2022] Open
Abstract
To treat patients with a catecholamine-secreting glomus jugulare tumor, perioperative management is important. Perioperative catecholamine hypersecretion causes severe problems in the treatment of a catecholamine-secreting glomus tumor. Therefore, a precise therapeutic strategy and perioperative management are required through collaboration of the endocrinology, anesthesiology, and endocrine surgery departments . We describe our perioperative management for catecholamine-secreting glomus jugulare tumor. The patient was a 31-year-old woman with a 50-mm glomus jugulare tumor and a significantly elevated plasma noradrenaline level of 21,165 pg/ml. Before the surgery, oral α − blocker administration was initiated for ∼ 3 months, and her body weight increased from 52 kg at the time of examination to 54.2 kg. Coil embolization of the tumor vessel was performed 1 week before surgery, and the intense tumor stain was reduced by 90%. The patient underwent almost total removal of the tumor via mastoidectomy with high cervical exposure via the transsigmoid approach. Postoperatively, plasma noradrenaline decreased markedly. Preoperative pharmacologic stabilization and peri- and postoperative anesthetic management are essential for the treatment of a catecholamine-secreting glomus jugulare tumor.
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Affiliation(s)
- Yu Teranishi
- Department of Neurosurgery and Stroke Center, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery and Stroke Center, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Shigeo Sora
- Department of Neurosurgery and Stroke Center, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hiroaki Sato
- Department of Neurosurgery and Stroke Center, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Naoko Haruyama
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
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Gandía-González ML, Kusak ME, Moreno NM, Sárraga JG, Rey G, Álvarez RM. Jugulotympanic paragangliomas treated with Gamma Knife radiosurgery: a single-center review of 58 cases. J Neurosurg 2014; 121:1158-65. [PMID: 24926654 DOI: 10.3171/2014.5.jns131880] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Jugulotympanic paragangliomas (JTPs) are rare benign tumors whose surgical treatment is usually associated with partial resection of the lesion, high morbidity, and even death. Gamma Knife radiosurgery (GKRS) has been reported as a useful treatment option. The goal of this retrospective study is to analyze the role of GKRS in tumor volume control and clinical outcomes of these patients. METHODS A total of 75 patients with JTPs were treated with GKRS at the authors' center from 1995 to 2012. The authors analyzed those treated during this period to allow for a minimal observation time of 2 years. The MR images and clinical reports of these patients were reviewed to assess clinical and volumetric outcomes of the tumors. The radiological and clinical assessments, along with a group of prognostic factors measured, were analyzed using descriptive methods. The time to volumetric and clinical progression was analyzed using the Kaplan-Meier method. Prognostic factors were identified using log-rank statistics and multivariate Cox regression models. RESULTS The mean follow-up was 86.4 months. The authors observed volumetric tumor control in 94.8% of cases. In 67.2% of cases, tumor volume decreased by a mean of 40.1% from the original size. Of patients with previous tinnitus, 54% reported complete recovery. Improvement of other symptoms was observed in 34.5% of cases. Overall, clinical control was achieved in 91.4% of cases. Previous embolization and familial history of paraganglioma were selected as significant prognostic factors for volumetric response to GKRS treatment in the univariate analysis. In multivariate analysis, no factors were significantly correlated with progression-free survival. No patient died of side effects related to GKRS treatment or tumor progression. CONCLUSIONS Gamma Knife radiosurgery is an effective, safe, and efficient therapeutic option for the treatment of these tumors as a first-line treatment or in conjunction with traditional surgery, endovascular treatment, or conventional fractionated radiotherapy.
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Chun SG, Nedzi LA, Choe KS, Abdulrahman RE, Chen SA, Yordy JS, Timmerman RD, Kutz JW, Isaacson B. A Retrospective Analysis of Tumor Volumetric Responses to Five-Fraction Stereotactic Radiotherapy for Paragangliomas of the Head and Neck (Glomus Tumors). Stereotact Funct Neurosurg 2014; 92:153-9. [DOI: 10.1159/000360864] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/21/2014] [Indexed: 11/19/2022]
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