Multisession Radiosurgery for Large Glomus Jugulare Tumors in and Around Jugular Foramen

Object The goal of this paper is to analyze the extension and relationships of glomus jugulare tumor with the temporal bone and the results of its surgical treatment aiming at preservation of the facial nerve. Based on the tumor extension and its relationships with the facial nerve, new criteria to be used in the selection of different surgical approaches are proposed. Methods Between December 1997 and December 2007, 34 patients (22 female and 12 male) with glomus jugulare tumors were treated. Their mean age was 48 years. The mean follow-up was 52.5 months. Clinical findings included hearing loss in 88%, swallowing disturbance in 50%, and facial nerve palsy in 41%. Magnetic resonance imaging demonstrated a mass in the jugular foramen in all cases, a mass in the middle ear in 97%, a cervical mass in 85%, and an intradural mass in 41%. The tumor was supplied by the external carotid artery in all cases, the internal carotid artery in 44%, and the vertebral artery in 32%. Preoperative embolization was performed in 15 cases. The approach was tailored to each patient, and 4 types of approaches were designed. The infralabyrinthine retrofacial approach (Type A) was used in 32.5%; infralabyrinthine pre- and retrofacial approach without occlusion of the external acoustic meatus (Type B) in 20.5%; infralabyrinthine pre- and retrofacial approach with occlusion of the external acoustic meatus (Type C) in 41%; and the infralabyrinthine approach with transposition of the facial nerve and removal of the middle ear structures (Type D) in 6% of the patients. Results Radical removal was achieved in 91% of the cases and partial removal in 9%. Among 20 patients without preoperative facial nerve dysfunction, the nerve was kept in anatomical position in 19 (95%), and facial nerve function was normal during the immediate postoperative period in 17 (85%). Six patients (17.6%) had a new lower cranial nerve deficit, but recovery of swallowing function was adequate in all cases. Voice disturbance remained in all 6 cases. Cerebrospinal fluid leakage occurred in 6 patients (17.6%), with no need for reoperation in any of them. One patient died in the postoperative period due to pulmonary complications. The global recovery, based on the Karnofsky Performance Scale (KPS), was 100% in 15% of the patients, 90% in 45%, 80% in 33%, and 70% in 6%. Conclusions Radical removal of glomus jugulare tumor can be achieved without anterior transposition of the facial nerve. The extension of dissection, however, should be tailored to each case based on tumor blood supply, preoperative symptoms, and tumor extension. The operative field provided by the retrofacial infralabyrinthine approach, or the pre- and retrofacial approaches, with or without closure of the external acoustic meatus, allows a wide exposure of the jugular foramen area. Global functional recovery based on the KPS is acceptable in 94% of the patients.

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JUGULAR FORAMEN AND EARLY ROENTGEN DIAGNOSIS OF GLOMUS JUGULARE TUMOR

American Journal of Roentgenology ◽

10.2214/ajr.97.3.597 ◽

1966 ◽

Vol 97 (3) ◽

pp. 597-600 ◽

Cited By ~ 3

Author(s):

SEUK KY KIM ◽

M. PAUL CAPP

Keyword(s):

Jugular Foramen ◽

Glomus Jugulare Tumor ◽

Glomus Jugulare ◽

Roentgen Diagnosis

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Microsurgical Resection of Glomus Jugulare Tumors With Facial Nerve Reconstruction: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy100 ◽

2018 ◽

Vol 16 (1) ◽

pp. E1-E1 ◽

Cited By ~ 2

Author(s):

Duarte N C Cândido ◽

Jean Gonçalves de Oliveira ◽

Luis A B Borba

Keyword(s):

Facial Nerve ◽

Infratemporal Fossa ◽

Tumor Resection ◽

Cranial Nerves ◽

Jugular Foramen ◽

Jugular Bulb ◽

Senior Author ◽

Nerve Reconstruction ◽

Glomus Jugulare ◽

Carotid Canal

Abstract Paragangliomas are tumors originating from the paraganglionic system (autonomic nervous system), mostly found at the region around the jugular bulb, for which reason they are also termed glomus jugulare tumors (GJT). Although these lesions appear to be histologically benign, clinically they present with great morbidity, especially due to invasion of nearby structures such as the lower cranial nerves. These are challenging tumors, as they need complex approaches and great knowledge of the skull base. We present the case of a 31-year-old woman, operated by the senior author, with a 1-year history of tinnitus, vertigo, and progressive hearing loss, that evolved with facial nerve palsy (House-Brackmann IV) 2 months before surgery. Magnetic resonance imaging and computed tomography scans demonstrated a typical lesion with intense flow voids at the jugular foramen region with invasion of the petrous and tympanic bone, carotid canal, and middle ear, and extending to the infratemporal fossa (type C2 of Fisch's classification for GJT). During the procedure the mastoid part of the facial nerve was identified involved by tumor and needed to be resected. We also describe the technique for nerve reconstruction, using an interposition graft from the great auricular nerve, harvested at the beginning of the surgery. We achieved total tumor resection with a remarkable postoperative course. The patient also presented with facial function after 6 months. The patient consented with publication of her images.

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Pathology of Jugular Foramen Neurofibroma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948309200206 ◽

1983 ◽

Vol 92 (2) ◽

pp. 128-133 ◽

Cited By ~ 7

Author(s):

Richard R. Gacek

Keyword(s):

Conservative Treatment ◽

Temporal Bone ◽

Cranial Nerves ◽

Internal Auditory Canal ◽

Jugular Foramen ◽

Glomus Jugulare Tumor ◽

Tissue Diagnosis ◽

Glomus Jugulare ◽

Useful Life

Tumors of jugular foramen may closely resemble glomus jugulare tumors clinically and radiographically. A tissue diagnosis is necessary to make a differentiation of these tumors. This conclusion is supported by the findings in a temporal bone from a patient who was diagnosed clinically as having a glomus jugulare tumor 57 years before her death at the age of 84 years. Compression of the 7th and 8th cranial nerves in the internal auditory canal and the 10th and 11th cranial nerves at the jugular foramen represents the mechanism of neural signs produced by a neurofibroma arising in the jugulare foramen. This case further demonstrates that conservative treatment of benign extradural tumors may be compatible with a long and useful life.

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Glomus Jugulare Presenting with Isolated Facial Nerve Palsy

Surgery Research and Practice ◽

10.1155/2014/514086 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Angelica A. Nunez ◽

Luis R. Ramos-Duran ◽

Albert C. Cuetter

Keyword(s):

Nerve Palsy ◽

Facial Nerve Palsy ◽

Cranial Nerves ◽

Petrous Bone ◽

Jugular Foramen ◽

Facial Weakness ◽

Glomus Jugulare ◽

Vascular Structures ◽

Lower Cranial Nerves ◽

Slow Growing

Glomus jugulare is a rare slow growing tumor occurring within the jugular foramen that rarely presents with isolated symptoms. Although histologically benign, these tumors are locally destructive because of their proximity to the petrous bone, the lower cranial nerves, and the major vascular structures (Miller et al. (2009) and Silverstone (1973)). We wish to report a glomus jugulare tumor eroding the petrous bone and producing an ipsilateral peripheral facial weakness. The mechanism of this erosion is discussed.

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Management of the Facial Nerve in Lateral Skull Base Surgery Analytic Retrospective study

Clinical Medicine Insights Ear Nose and Throat ◽

10.4137/cment.s6570 ◽

2011 ◽

Vol 4 ◽

pp. CMENT.S6570 ◽

Cited By ~ 1

Author(s):

Mohamed A. El Shazly ◽

Mahmoud A.M. Mokbel ◽

Amr A. Elbadry ◽

Hatem S. Badran

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Tumor Resection ◽

Cranial Nerves ◽

Jugular Foramen ◽

External Carotid ◽

Vascular Tumors ◽

Complete Cure ◽

Glomus Jugulare ◽

Lateral Skull Base

Background Surgical approaches to the jugular foramen are often complex and lengthy procedures associated with significant morbidity based on the anatomic and tumor characteristics. In addition to the risk of intra-operative hemorrhage from vascular tumors, lower cranial nerves deficits are frequently increased after intra-operative manipulation. Accordingly, modifications in the surgical techniques have been developed to minimize these risks. Preoperative embolization and intra-operative ligation of the external carotid artery have decreased the intraoperative blood loss. Accurate identification and exposure of the cranial nerves extracranially allows for their preservation during tumor resection. The modification of facial nerve mobilization provides widened infratemporal exposure with less postoperative facial weakness. The ideal approach should enable complete, one stage tumor resection with excellent infratemporal and posterior fossa exposure and would not aggravate or cause neurologic deficit. The aim of this study is to present our experience in handling jugular foramen lesions (mainly glomus jugulare) without the need for anterior facial nerve transposition. Methods In this series we present our experience in Kasr ElEini University hospital (Cairo–-Egypt) in handling 36 patients with jugular foramen lesions over a period of 20 years where the previously mentioned preoperative and operative rules were followed. The clinical status, operative technique and postoperative care and outcome are detailed and analyzed in relation to the outcome. Results Complete cure without complications was achieved in four cases of congenital cholesteatoma and four cases with class B glomus. In advanced cases of glomus jugulare (28 patients) (C and D stages) complete cure was achieved in 21 of them (75%). The operative complications were also related to this group of 28 patients, in the form of facial paralysis in 20 of them (55.6%) and symptomatic vagal paralysis in 18 of them (50%). Conclusions Total anterior rerouting of the facial nerve carries a high risk of facial paralysis. So it should be reserved for cases where the lesion extends beyond the vertical ICA. Otherwise, for less extensive lesions and less aggressive pathologies, less aggressive approaches could be adopted with less hazards.

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