A Case of Catecholamine-Secreting Glomus Jugulare Tumor: Treatment Strategy and Perioperative Management

Introduction: Advances of neuroimaging, skull base technique, and embolization improve outcome in patients who present with tumor of the glomus jugulare. Catecholamine- secreting subgroup, however, is considered to be extremely high risk because of the potentially serious complication of an intra- and perioperative hypertension crisis. The authors present a detailed description of treatment strategy and perioperative management with a catecholamine-secreting glomus jugulare.

Methods: A 57-year-old woman in whom the noradrenaline level in plasma was 20 times higher than normal presented with uncontrolled labile hypertension and carcinoid syndrome. Magnetic resonance imaging and 123Imeta-iodobenzylguanidine (MIBG) scan depicted the tumor originating from the jugular foramen extending to the infratemporal fossa. Alpha catecholamine blocker and magnesium sulfate was commenced prior to embolization and surgery. Under the cranial nerve and hemodynamic monitoring, tumor resection via infratemporal fossa type A was performed.

Results: The patient remained hemodynamically stable and the lower cranial nerve injury could be avoided. The plasma noradrenaline level decreased and hypertension became normalized.

Conclusion: We emphasize treatment strategy and intra- and perioperative management of this rare entity.