Clinical Features and Surgical Outcomes of Glomus Tumors in the Temporal Bone and Skull Base / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Glomus tumors are benign, slow-growing tumors which cause various symptoms such as pulsatile tinnitus and hearing loss. The aim of this study was to analyze the clinical manifestation and surgical outcomes of the glomus tumors in the temporal bone and skull base. SUBJECTS AND METHOD: Medical records of 17 patients who were surgically managed for glomus tumors of the temporal bone and skull base from 1997 to 2013 were retrospectively reviewed. The location and the size of the tumor were analyzed by CT and MRI, and the Fisch classification method was used to classify the tumor. Pre- and postoperative facial function measured by House-Brackmann (H-B) grade and lower cranial nerve (LCN) function were collected. RESULTS: The mean age of 17 patients was 50.6 (18-83) years, and male to female ratio was 4:13. The most common symptom of glomus tumors was pulsatile tinnitus, and this symptom disappeared or changed naturally postoperatively. The majority of patients with glomus jugulare showed various degrees of immediate postoperative facial nerve palsy, and 8 out of 9 patients showed improvement of facial nerve function to H-B grade I in 3 months. LCN palsy occurred in 5 out of 9 patients immediately following the operation and remained in 3 patients with Fisch type C2 tumor. CONCLUSION: Glomus tumors of the temporal bone and skull base were successfully removed by surgery. The surgical outcome of glomus jugulare shows that facial nerve function is acceptable and the incidence of lower cranial nerve palsy may be related to the classification of tumor.

Delayed Unilateral Soft Palate Palsy without Vocal Cord Involvement after Microvascular Decompression for Hemifacial Spasm

Microvascular decompression is a very effective and relatively safe surgical modality in the treatment of hemifacial spasm. But rare debilitating complications have been reported such as cranial nerve dysfunctions. We have experienced a very rare case of unilateral soft palate palsy without the involvement of vocal cord following microvascular decompression. A 33-year-old female presented to our out-patient clinic with a history of left hemifacial spasm for 5 years. On postoperative 5th day, patient started to exhibit hoarsness with swallowing difficulty. Symptoms persisted despite rehabilitation. Various laboratory work up with magnetic resonance image showed no abnormal lesions. Two years after surgery patient showed complete recovery of unitaleral soft palate palsy. Various etiologies of unilateral soft palate palsy are reviewed as the treatment and prognosis differs greatly on the cause. Although rare, it is important to keep in mind that such complication could occur after microvascular decompression.

Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma

A case of idiopathic hypertrophic cranial pachymeningitis (IHCP) misdiagnosed as an acute subdural hematoma is reported. A 37-year-old male patient presented with headache following head trauma 2 weeks earlier. Computerized tomography showed a diffuse high-density lesion along the left tentorium and falx cerebri. Initial chest X-rays revealed a small mass in the right upper lobe with right lower pleural thickening, which suggested lung cancer, such as an adenoma or mediastinal metastasis. During conservative treatment under the diagnosis of a subdural hematoma, left cranial nerve palsies were developed (3rd and 6th), followed by scleritis and uveitis involving both eyes. Magnetic resonance imaging (MRI) revealed an unusual tentorium-falx enhancement on gadolinium-enhanced T1-weighted images. Non-specific chronic inflammation of the pachymeninges was noticed on histopathologic examination following an open biopsy. Systemic steroid treatment was initiated, resulting in dramatic improvement of symptoms. A follow-up brain MRI showed total resolution of the lesion 2 months after steroid treatment. IHCP should be included in the differential diagnosis of subtentorial-enhancing lesions.

Fracture of the OccipitalvCondyle Associated with Lower Cranial Nerve Palsy

We describe the case of a 59-year-old man whose occipital condyle was fractured in a traffic accident, resulting in severe neck pain and blurred vision. Neurological examination revealed palsy of the right side sixth cranial and ipsilateral lower cranial nerve. In fracture of the occipital condyle, persistent neck pain and lower cranial nerve palsy may be common clinical features. Conventional plain radiography may often be inadequate for the detection and evaluation of this lesion, and high-resolution CT and coronal reconstruction is the diagnostic modality of choice. The patient was treated conservatively using a Philadelphia collar, and this led to excellent clinical improvement. To demonstrate this rare form of traumatic lesion in patients with sustained post-traumatic neck pain and lower cranial nerve palsy, the authors recommend CT of the craniocervical junction.

Fracture of the OccipitalvCondyle Associated with Lower Cranial Nerve Palsy

We describe the case of a 59-year-old man whose occipital condyle was fractured in a traffic accident, resulting in severe neck pain and blurred vision. Neurological examination revealed palsy of the right side sixth cranial and ipsilateral lower cranial nerve. In fracture of the occipital condyle, persistent neck pain and lower cranial nerve palsy may be common clinical features. Conventional plain radiography may often be inadequate for the detection and evaluation of this lesion, and high-resolution CT and coronal reconstruction is the diagnostic modality of choice. The patient was treated conservatively using a Philadelphia collar, and this led to excellent clinical improvement. To demonstrate this rare form of traumatic lesion in patients with sustained post-traumatic neck pain and lower cranial nerve palsy, the authors recommend CT of the craniocervical junction.