Glomus Tumors in the Head and Neck: III. Analysis of Clinical Manifestations

Spector, Gershon J.; Ciralsky, Robert H.; Ogura, Joseph H.

doi:10.1177/000348947508400111

Cited by 45 publications

(19 citation statements)

References 8 publications

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“…Systemic disorders of high output (i.e., anemia, thyrotoxicosis, valve heart disease), arteriovenous malformations, DAVFs, arterial wall diseases (i.e., dissection, atherosclerosis, aneurysm), skull base tumors, and intracranial hypertension may all cause pulsatile tinnitus with normal findings on otoscopy. 1,4,7,11,[15][16][17] In patients with normal findings on otoscopy and pulsatile tinnitus, experience from this study suggests that CT scan is less sensitive in diagnosis of vascular abnormalities. Only 16% (1 of 6) of the CT studies correctly diagnosed the lesion (excluding the 10 patients CT ϭ computed tomography; MRI ϭ magnetic resonance imaging; MRA ϭ magnetic resonance angiography; SAH ϭ subarachnoid hemorrhage; TS DAVF ϭ transverse/sigmoid sinus dural arteriovenous fistula; SA ϭ selective angiography.…”

Section: Discussionmentioning

confidence: 82%

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Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus

2000

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Objectives/Hypothesis: Pulsatile tinnitus in the face of normal findings on otoscopy is a common otological diagnostic dilemma and can be due to serious vascular malformations such as transverse or sigmoid sinus dural arteriovenous fistula (transverse or sigmoid sinus [TS] DAVF). Left untreated, TS DAVF may result in significant morbidity and mortality. TS DAVF can be suspected or diagnosed with computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA), with the gold standard being angiography. Our objective was to assess the utility of these various diagnostic modalities in the diagnosis of dural arteriovenous fistula. Study Design: Retrospective clinical review. Methods: Between 1986 and 1996, 54 patients were evaluated and treated for TS DAVF. Between 1996 and 1999, an additional 33 patients underwent MRI combined with MRA for the evaluation of pulsatile tinnitus. A retrospective review of the medical records for both groups, with special attention to clinical presentation, diagnostic evaluation, therapy, and outcome, was performed. Results: All patients had pulsatile tinnitus with normal findings on otoscopy. CT scan was relatively insensitive in the detection of TS DAVF. MRI and MRI/MRA were significantly more sensitive than CT. In the evaluation of patients with subjective pulsatile tinnitus, MRI/MRA defined anatomical abnormalities that may contribute to pulsatile tinnitus in 63% of patients. Conclusions: In the absence of objective pulsatile tinnitus, MRI/MRA is an appropriate initial diagnostic step. When a patient has an objective bruit, the clinician may choose to proceed directly to angiography to make certain that a TS DAVF is not missed.

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Section: Discussionmentioning

confidence: 82%

“…Paget's disease 14 Cavernous hemangioma 15 Glomus tumor 16 Miscellaneous Anemia, high cardiac output 17 AVM ϭ arteriovenous malformation; DAVF ϭ dural arteriovenous fistula; ICA ϭ internal carotid artery.…”

Section: Magnetic Resonance Imaging and Magnetic Resonance Angiographymentioning

confidence: 99%

Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus

2000

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“…This series is also typical in the 2-to 3-year delay between the onset of symptoms, referral, and diagnoSiS. 16,17 This is due to both the slow growth of these tumors and the vague symptoms, for example, tinnitis, with which they often present.…”

Section: Discussionmentioning

confidence: 82%

An Update on the Surgical Treatment of Temporal Bone Paraganglioma

Moe

Linder

et al. 2000

Rivista di Neuroradiologia

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In 1982, Fisch described his results for the surgical treatment of 74 paragangliomas of the temporal bone, 5 years after his description of the infratemporal fossa approaches (types A and B). This study reviews the subsequent experience of the Department of Otolaryngology—Head and Neck Surgery of the University of Zürich with more than 136 surgically treated cases of paraganglioma of the temporal bone and discusses our current therapy 20 years after the initial description. One hundred nineteen (90%) of the patients had advanced tumors (Fisch class C or C+D), and 81 (68%) had intracranial extension. Total tumor excision was possible in 109 (82%) patients. Subtotal excision was performed in 22 (17%) patients, 21 of whom had intradural tumor invasion. In these cases, the resection was limited not by actual tumor size but by the degree of intracranial intradural tumor extension. Partial tumor excision was undertaken in only 1 patient with a C4De2Di2 tumor. The success rate in preservation of function of the lower cranial nerves was encouraging. Of the 69 patients whose facial nerve status was followed postoperatively, 81% maintained Fisch grade 76 to 100% (House-Brackman grades I and II). Analysis of follow-up data ranging from 2 to 11 years demonstrated 98% disease-free survival when total tumor extirpation was possible. In the patients who underwent subtotal or partial surgical resection there has been no subsequent tumor growth detected by either clinical or neuroradiological evaluation. We have confirmed after more than 20 years of experience that the infratemporal fossa approaches are a safe, highly effective means of surgical management of paragangliomas of the temporal bone, allowing eradication or arrest of disease with minimal morbidity. Limited intradural surgical resection in cases of very extensive tumors can greatly benefit patients for whom complete excision is not an option.

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“…None of these investigations showed an abnormality that could explain pulsatile tinnitus. [58] Dural arteriovenous fistula [2,13,23,24,34,38,55] Carotid cavernous fistula [42] Aneurysm of the ICA [3,12] Fibromuscular dysplasia of the ICA [ 17,56] Dissection of the ICA [33,50] Atherosclerosis [7,16,30,44] Occlusion of the contralateral CCA [35] Vascular anomalies of the ear [8,20,28,49] Vascular compression of the VIII nerve [27,37] Migraine [52] Jugular bulb anomalies [1,391 Abnormal condylar and mastoid emissary veins [19,25] Glomus tumor [26,36,48] Paget's disease [14] Cavernous haemangioma [51] Histiocytosis X [5] Intracranial hypertenison of various causes [14,31,32,45,46] Anaemia, high cardiac output [9,11] Palatal myoclonus [4,22] Abnormally paten...…”

Section: Unknown Pathologymentioning

confidence: 99%

Pulsatile tinnitus —a review of 84 patients

et al. 1998

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Pulsatile tinnitus can be annoying for a patient and can also be the only clue to a potentially devastating and life-threatening disease. In order to understand its clinical spectrum and management better we analysed the files of 84 patients seen at our institution over a 10-year period. Noninvasive techniques (ultrasound, computed tomography, magnetic resonance imaging) and angiography were employed as investigations tailored to the individual patient. A vascular disorder [i.e. arteriovenous fistula, dissection of the internal carotid artery (ICA), fibromuscular dysplasia, aneurysm of the ICA and sinus thrombosis] was found in 36 patients (42%), most commonly a dural arteriovenous fistula or a carotid-cavernous sinus fistula. In 26 patients with a vascular abnormality, pulsatile tinnitus was the presenting symptom. In 12 patients (14%), nonvascular disorders such as glomus tumour or intracranial hypertension with a variety of causes explained the tinnitus. We conclude that patients with pulsatile tinnitus should be investigated with noninvasive techniques. If these are negative or to clarify abnormal findings of noninvasive techniques selective angiography is needed for diagnosis and to guide treatment.

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Glomus Tumors in the Head and Neck: III. Analysis of Clinical Manifestations

Cited by 45 publications

References 8 publications

Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus

Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus

An Update on the Surgical Treatment of Temporal Bone Paraganglioma

Pulsatile tinnitus —a review of 84 patients

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