J Neurol Surg B Skull Base 2012; 73(03): 197-207
DOI: 10.1055/s-0032-1312707
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Management of Giant Transdural Glomus Jugulare Tumors with Cerebellar and Brainstem Compression

Matthew L. Carlson
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Colin L. W. Driscoll
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Joaquin J. Garcia
3   Department of Laboratory Medicine and Pathology, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Jeffrey R. Janus
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Michael J. Link
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
› Author Affiliations
Further Information

Publication History

24 August 2010

23 February 2011

Publication Date:
17 May 2012 (online)

Abstract

Objective The objective of this study is to discuss the management of advanced glomus jugulare tumors (GJTs) presenting with intradural disease and concurrent brainstem compression.

Study Design This is a retrospective case series.

Results Over the last decade, four patients presented to our institution with large (Fisch D2; Glasscock-Jackson 4) primary or recurrent GJTs resulting in brainstem compression of varying severities. All patients underwent surgical resection through a transtemporal, transcervical approach resulting in adequate brainstem decompression; the average operative time was 12.75 hours and the estimated blood loss was 2.7 L. All four patients received postoperative adjuvant radiotherapy in the form of intensity-modulated radiation therapy or stereotactic radiosurgery. Combined modality treatment permitted tumor control in all patients (range of follow-up 5 to 9 years).

Conclusion A small subset of GJTs may present with intracranial transdural extension with aggressive brainstem compression mandating surgical intervention. Surgical resection is extremely challenging; the surgical team must be prepared for extensive operating time and the patient for prolonged aggressive rehabilitation. Newly diagnosed and recurrent large GJTs involving the brainstem may be controlled with a combination of aggressive surgical resection and postoperative radiation.

 
  • References

  • 1 Glasscock III ME. The history of glomus tumors: a personal perspective. Laryngoscope 1993; 103 (11 Pt 2, Suppl 60) 3-6
  • 2 Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 2002; 97 (6) 1356-1366
  • 3 Michael II LM, Robertson JH. Glomus jugulare tumors: historical overview of the management of this disease. Neurosurg Focus 2004; 17 (2) E1
  • 4 Jackson CG, Glasscock III ME, Harris PF. Glomus tumors. Diagnosis, classification, and management of large lesions. Arch Otolaryngol 1982; 108 (7) 401-410
  • 5 Fayad JN, Schwartz MS, Brackmann DE. Treatment of recurrent and residual glomus jugulare tumors. Skull Base 2009; 19 (1) 92-98
  • 6 van der Mey AG, Frijns JH, Cornelisse CJ , et al. Does intervention improve the natural course of glomus tumors? A series of 108 patients seen in a 32-year period. Ann Otol Rhinol Laryngol 1992; 101 (8) 635-642
  • 7 Sanna M, Jain Y, De Donato G, Rohit, Lauda L, Taibah A. Management of jugular paragangliomas: the Gruppo Otologico experience. Otol Neurotol 2004; 25 (5) 797-804
  • 8 Jackson CG, McGrew BM, Forest JA, Netterville JL, Hampf CF, Glasscock III ME. Lateral skull base surgery for glomus tumors: long-term control. Otol Neurotol 2001; 22 (3) 377-382
  • 9 Brown JS. Glomus jugulare tumors revisited: a ten-year statistical follow-up of 231 cases. Laryngoscope 1985; 95 (3) 284-288
  • 10 Anand VK, Leonetti JP, al-Mefty O. Neurovascular considerations in surgery of glomus tumors with intracranial extensions. Laryngoscope 1993; 103 (7) 722-728
  • 11 Patel SJ, Sekhar LN, Cass SP, Hirsch BE. Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases. J Neurosurg 1994; 80 (6) 1026-1038
  • 12 Simpson II GT, Konrad HR, Takahashi M, House J. Immediate postembolization excision of glomus jugulare tumors: advantages of new combined techniques. Arch Otolaryngol 1979; 105 (11) 639-643
  • 13 Murphy TP, Brackmann DE. Effects of preoperative embolization on glomus jugulare tumors. Laryngoscope 1989; 99 (12) 1244-1247
  • 14 Gardner G, Cocke Jr EW, Robertson JT, Trumbull ML, Palmer RE. Combined approach surgery for removal of glomus jugulare tumors. Laryngoscope 1977; 87 (5 Pt 1) 665-688
  • 15 Fisch U. Infratemporal fossa approach to tumours of the temporal bone and base of the skull. J Laryngol Otol 1978; 92 (11) 949-967
  • 16 Netterville JL, Civantos FJ. Rehabilitation of cranial nerve deficits after neurotologic skull base surgery. Laryngoscope 1993; 103 (11 Pt 2, Suppl 60) 45-54
  • 17 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (2) 146-147
  • 18 Alford BR, Guilford FR. A comprehensive study of tumors of the glomus jugulare. Laryngoscope 1962; 72: 765-805
  • 19 Guild SR. The glomus jugulare, a nonchromaffin paraganglion, in man. Ann Otol Rhinol Laryngol 1953; 62 (4) 1045-1071 concld
  • 20 Green Jr JD, Brackmann DE, Nguyen CD, Arriaga MA, Telischi FF, De la Cruz A. Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 1994; 104 (8 Pt 1) 917-921
  • 21 Al-Mefty O, Fox JL, Rifai A, Smith RR. A combined infratemporal and posterior fossa approach for the removal of giant glomus tumors and chondrosarcomas. Surg Neurol 1987; 28 (6) 423-431
  • 22 Jackson CG, Glasscock III ME, McKennan KX , et al. The surgical treatment of skull-base tumors with intracranial extension. Otolaryngol Head Neck Surg 1987; 96 (2) 175-185
  • 23 Kinney SE. Glomus jugulare tumor surgery with intracranial extension. Otolaryngol Head Neck Surg 1980; 88 (5) 531-535
  • 24 Carlson RD, Sasaki CT, Friedman SI, Spencer D. Glomus tympanicum tumor with middle cranial fossa extension. Otolaryngol Head Neck Surg 1987; 96 (2) 186-189
  • 25 Jackson CG, Harris PF, Glasscock III ME , et al. Diagnosis and management of paragangliomas of the skull base. Am J Surg 1990; 159 (4) 389-393
  • 26 Ramina R, Maniglia JJ, Fernandes YB , et al. Jugular foramen tumors: diagnosis and treatment. Neurosurg Focus 2004; 17 (2) E5
  • 27 Hawthorne MR, Makek MS, Harris JP, Fisch U. The histopathological and clinical features of irradiated and nonirradiated temporal paragangliomas. Laryngoscope 1988; 98 (3) 325-331
  • 28 Schwaber MK, Gussack GS, Kirkpatrick W. The role of radiation therapy in the management of catecholamine-secreting glomus tumors. Otolaryngol Head Neck Surg 1988; 98 (2) 150-154
  • 29 Cole JM, Beiler D. Long-term results of treatment for glomus jugulare and glomus vagale tumors with radiotherapy. Laryngoscope 1994; 104 (12) 1461-1465
  • 30 Genc A, Bicer A, Abacioglu U , et al. Gamma knife radiosurgery for the treatment of glomus jugulare tumors. J Neurooncol 2009; 97 (1) 101-108
  • 31 Lalwani AK, Jackler RK, Gutin PH. Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor. Am J Otol 1993; 14 (4) 398-402
  • 32 Huy PT, Kania R, Duet M, Dessard-Diana B, Mazeron JJ, Benhamed R. Evolving concepts in the management of jugular paraganglioma: a comparison of radiotherapy and surgery in 88 cases. Skull Base 2009; 19 (1) 83-91
  • 33 Kapadia SB. In: Barnes L, ed. Surgical Pathology of the Head and Neck V. 2nd ed. New York: Marcel Dekker, Inc; 2001: 787-888
  • 34 Gjuric M, Gleeson M. Consensus statement and guidelines on the management of paragangliomas of the head and neck. Skull Base 2009; 19 (1) 109-116
  • 35 Leonetti JP, Brackmann DE, Prass RL. Improved preservation of facial nerve function in the infratemporal approach to the skull base. Otolaryngol Head Neck Surg 1989; 101 (1) 74-78
  • 36 Leonetti JP, Anderson DE, Marzo SJ, Origitano TC, Vandevender D, Quinonez R. Facial paralysis associated with glomus jugulare tumors. Otol Neurotol 2007; 28 (1) 104-106
  • 37 Borba LA, Ale-Bark S, London C. Surgical treatment of glomus jugulare tumors without rerouting of the facial nerve: an infralabyrinthine approach. Neurosurg Focus 2004; 17 (2) E8
  • 38 May M. Nerve repair. In: May M, ed. The Facial Nerve. 2nd ed. New York: Thieme; 2000: 571-610
  • 39 Link MJ, Converse LD, Lanier WL. A new technique for single-person fascia lata harvest. Neurosurgery 2008; 63 (4, Suppl 2) 359-361 , discussion 361
  • 40 Yoshida K, Katayama M, Kuroshima Y , et al. Glomus jugulare tumor presenting with intracerebellar hemorrhage. Skull Base Surg 2000; 10 (2) 101-105