Glomus jugulare tumours: A review of 61 cases

Abstract

A retrospective study of 61 patients with glomus jugulare tumours treated at the National Hospital for Neurology and Neurosurgery, and at the Royal National Throat, Nose and Ear Hospital, London. The average age at presentation was 41.7 years. The patients were mainly treated by a posterolateral combined otoneurosurgical approach. 42/61 of the patients had total or subtotal excision of their tumours, 7/61 had partial removal and the remaining 11/61 had no operation. Only one case required a 2-staged procedure. There were two deaths in the postoperative period, one from intracerebral haemorrhage and the other from the left hemisphere infarction. Postoperative radiotherapy was given to 5/7 of the patients who had partial removal. 3/40 of the patients with total removal had postoperative radiotherapy, and a further 3/40 had received radiotherapy pre-operatively. Of the 11 patients who did not undergo surgery, 7/11 were treated with radiotherapy and 4/11 had embolisation only.

Successful treatment of glomus jugulare tumours with gamma knife radiosurgery: clinical and physical aspects of management and review of the literature

“…Unfortunately, signifi cant morbidities can frequently result from surgery, typically related to cranial nerves 7 and most commonly 9 through 12, including but not limited to: facial weakness or paralysis, swallowing dysfunction, taste dysfunction, autonomic dysfunction, hoarseness, weakness of neck muscles, and hearing loss or vestibular dysfunction. In the Gottfried review, the rate of new onset cranial nerve defi cits in those series providing data on cranial nerve dysfunction was approximately 58% [18,21]. In several additional older studies on resection, the cranial nerve defi cit rates are reported to vary anywhere from 22% to as high as 83%.…”

“…Regardless of the surgical technique, due to tumour locations, total resection is not always possible, particularly with "complex" tumours (giant tumours, multiple paragangliomas, malignant tumours, those with catecholamine secretion, or those with previous surgical or other therapies). Upon review of multiple series, such as those included in the review by Gottfried et al [15] (374 patients from 7 series) [4,6,18,[20][21][22][23], and excluding those that included more complex tumours, total resection has been achieved in about 85-96% of cases. Surgical resection rates for complex tumour rates are not quite as high, but still in the range of 83-86% [20,23].…”

“…Newer advanced microsurgical techniques that utilise facial or other nerve monitoring and limit nerve transposition as much as possible may also have lower rates of cranial neuropathies [20]. In addition to the potential cranial nerve effects from surgery, other postoperative complications can occur, including cerebrospinal fl uid leaks (8.3%), aspiration (5.5%), pneumonia (2.3%), wound infection (2.1%) or meningitis (2.1%) [4,6,18,[20][21][22][23]. Surgical mortality is rare (1%) [18,21].…”

Leksell Gamma Knife Radiosurgery of the Tumor Glomus Jugulare and Tympanicum

“…Neuropathy of the facial nerve was present in 16-23% necessitating tarsorraphy. Paresis of the VIth nerve occurred in 6%, and a hearing impairment or deafness was noticed in 4-26% [2,4,6,7,10]. After surgical removal of the tumor, it is important to keep in mind that at least 15% of the patients will not be able to have the same kind of lifestyle as they had before surgery [10].…”

Fractionated Stereotactic Radiotherapy of Glomus Jugulare Tumors

“…After resection, progression-free survival was achieved in 92-94.5% (median follow-up 38-54 months) [2,17]. New LCNP occurred in 57% [34]. To minimize postoperative neurologic deficits, stereotactic radiosurgery (SRS) was performed as an alternative treatment option.…”