Microsurgical Resection of Multiple Giant Glomus Tumors

Acta Neurochirurgica, 2009

2017

Paragangliomas, also known as glomus tumours or chemodectomas, are neuroendocrine tumours that originate from glomus cells in paraganglia. They are derived from the embryonal neural crest. The cells are part of the sympathetic nervous system and serve as chemoreceptors. They are located in the vascular adventitia of blood vessels which include the carotid bodies in the carotid artery bifurcation (Figure 1).

Skull Base, 1993

Preoperative embolization of paragangliomas (glomus tumors) is widely used to devascularize glomus tumors in any location of the head and neck.1-10 The most commonly employed materials for embolization are Gelfoam and polyvinyl alcohol (PVA) foam. The use of Gelfoam is rather limited because of its rapid reabsorption rate. PVA (also known as Ivalon) is biocompatible, nonabsorbable, and, if used in microparticles of 200 to 500 ,m, causes effective tumor devascularization.4,5 Definitive thrombosis and hemorrhagic necrosis of several renal cortex arteries with no lysis or fragmentation of embolic material were found 7 days after embolization of renal arteries using PVA in dogs.1' Microscopic examination of human specimens removed after two fatalities, which occurred after embolization with PVA for symptomatic neonatal hepatic arteriovenous malformation,12 revealed in one case intravascular giant cell reaction, medial and adventitial hypertrophy, and recanalization of the vascular lumen. A review of the literature failed to reveal further histopathologic studies on embolic agents. Therefore, the surgical specimens and the clinical data of 45 patients embolized and operated on at the ENT Department of the University of Zurich for head and neck paragangliomas were reviewed. The aim of this study was to determine the histopathologic changes occurring in the tumors after embolization and to correlate these with the clinical data.

E Journal of Cardiovascular Medicine

Carotid body tumors are rare paragangliomas and generally they have benign characters. Only 3% of all paragangliomas occur in the head and neck region. Surgical procedure of carotid body tumor has a high rate neurological morbidity because of a close comminication with neurovascular formations. We report here a very rare case of glomus tumor threated surgically.

Otolaryngologic Clinics of North America, 2007

2011

To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin’s Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.

Open Medicine, 2010

Glomus caroticum tumors, usually used as an alternative term for carotid body tumor, are of neuroectodermal origin and a part of the extra adrenal neuroendocrine system pathologies. These abnormalities are the most frequently detected paraganglioma in the localization of the head and neck. In our report, we present a giant tumor mass on the left side which was operated on successfully with a review of our experience retrospectively. Between the dates of June 1995 and October 2009, 47 patients, all of which had a glomus caroticum tumor, underwent to surgery. Tumor presented a wide variety of size and clinical presentations.

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2013

Glomus tumors are rare and locally aggressive, vascular paragangliomas of the skull base. Tumors may progress to cause lower cranial nerve palsies and involve the major vascular structure in the skull base, and thus pose very difficult surgical challenges. One such case is presented, the management problems in such "complex glomus jugulare" tumors are discussed, and the literature reviewed.

Journal of Neurosurgery, 2002

Object. Tumors of the glomus jugulare are benign, slow-growing paragangliomas. Their natural history, surgical treatment, and outcome have been well addressed in the recent literature; however, there remains a subgroup of complex tumors—multiple, giant, malignant, neuropeptide-secreting lesions, and those treated previously by an intervention with an adverse outcome—that is high risk, presents surgical challenges, and is associated with treatment controversy. In this article the authors report on a series of patients with complex glomus jugulare tumors and focus on treatment decisions, avoidance of complications, surgical refinements, and patient outcomes. Methods. In this retrospective study, the patient population was composed of 11 male and 32 female patients (mean age 47 years) with complex tumors of the glomus jugulare who were treated by the senior author within the past 20 years. These include 38 patients with giant tumors, 11 with multiple paragangliomas (seven bilateral and...

American Journal of Otolaryngology, 1997