Pathophysiology of sensorineural hearing loss in jugular foramen paraganglioma.

OBJECTIVES/HYPOTHESIS: Pathologic involvement of the inferior cochlear vein is a mechanism of sensorineural hearing loss in patients with jugular foramen paraganglioma. STUDY DESIGN: Retrospective case-control study. METHODS: The presenting audiograms, magnetic resonance imaging, and computed tomography were reviewed in 46 subjects with jugular foramen paragangliomas. Four-frequency bone conduction average was compared between the tumor and nontumor ears in each subject to establish the presence of sensorineural hearing loss. Imaging findings for each subject were recorded. Univariate and multivariate statistical analyses were performed to determine which radiographic features were associated with sensorineural hearing loss. Hearing data were analyzed as a continuous variable and as a categorical variable. RESULTS: Twenty subjects (43.4%) had a bone-conduction pure-tone asymmetry of greater than 15 dB. Inferior cochlear vein involvement was identified in 19 of the 20 (95%) subjects with sensorineural hearing loss. Inferior cochlear vein involvement was found to be a statistically significant predictor of sensorineural hearing loss using univariate and multivariate analyses. Other imaging findings that were statistically significant predictors of sensorineural hearing loss include Glasscock-Jackson stage, Fisch-Mattox stage, hypoglossal canal involvement, jugulo-carotid spin erosion, and petrous carotid canal erosion. CONCLUSIONS: Involvement of the inferior cochlear vein appears to be a plausible mechanism for sensorineural hearing loss in patients with jugular foramen paraganglioma. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:67-75, 2019.

Facial nerve management in jugular paraganglioma surgery: a literature review.

OBJECTIVE: This literature review analysed facial nerve management strategies in jugular paraganglioma surgery and discusses the tumour resection rate and the facial nerve outcome associated with each technique. METHODS: A retrospective review of PubMed and Medline articles on the surgical treatments for jugular paraganglioma was performed. Tumour resection rates and post-operative facial nerve function after non-rerouting, short anterior rerouting and long anterior rerouting approaches were evaluated for each article. RESULTS: A total of 15 studies involving a total of 688 patients were included. Post-operative facial nerve function was similar after non-rerouting and short anterior rerouting approaches (p = 0.169); however, both of these techniques had significantly better post-operative facial nerve outcomes compared with long anterior rerouting (p < 0.001 and p = 0.001, respectively). The total tumour removal rate was significantly higher for long anterior rerouting than with the non-rerouting approach (p = 0.016). There was no difference in total tumour removal rate between the long and short anterior rerouting approaches (p = 0.067) and between the short anterior rerouting and non-rerouting approaches (p = 0.867). CONCLUSION: No strict guidelines for facial nerve management in jugular paraganglioma resection are available. Although long anterior rerouting provides the best tumour exposure along with a low morbidity rate, case-by-case selection of the surgical approach is recommended.

[The arrest of bleeding from the sigmoid sinus and the upper segments of internal jugular vein].

The objective of the present work was to develop an efficacious non-injurious technique for the arrest of hemorrhage from the sigmoid sinus and the upper segments of the internal jugular vein. The authors proposed a relatively simple and highly effective method to be used to the blockade of the sigmoid sinus. It was employed to treat 8 patients none of whom suffered complications in the late postoperative period (the follow-up study lasting from 6 months to 2 years after the intervention).

The combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach for resection of glomus jugulare tumors.

Complex tumors OF the glomus jugulare present a surgical challenge because of their difficult location, extreme vascularity, and involvement with multiple cranial nerves. Modern microneurosurgical and cranial base techniques have enabled safe total removal of these complicated tumors. We describe a one-stage transjugular posterior infratemporal fossa approach for radical resection of glomus jugulare tumors located around the jugular foramen, the lower clivus, and the high cervical region from an anterolateral direction. This approach is a combination of transmastoid, suprajugular, transjugular, extreme lateral infrajugular transcondylar transtubercular, and high cervical approaches. Total exposure of the jugular foramen can be achieved, and multidirectional approaches can be performed, including infralabyrinthine/suprajugular, retrosigmoid/transcondylar/infrajugular, and transjugular exposures. Exposure of the vertical C7 segment of the infratemporal internal carotid artery and the lower clivus can be performed without permanent rerouting of the facial nerve. The details of this approach are described and illustrated in a stepwise fashion, and the microsurgical anatomy is reviewed.

[Main symptom: "pulse-synchronous tinnitus"]. / Hauptsymptom: "Pulssynchrones Ohrgeräusch".

BACKGROUND: In comparison to cochlear or nerval generated ear noises, pulsatile tinnitus is a rare condition. Due to its own etiology, specific diagnostic steps are necessary. PATIENTS: We present 6 patients with pulsating tinnitus as the leading symptom. By means of these cases the various etiologies, rational diagnosis and therapy will be discussed. RESULTS: Pulsatile tinnitus is frequently caused by an increased blood flow in the cranial vessels through various pathologies. Besides those diseases going along with a general increase of blood circulation, regional alterations can be classified as hypervascular/hyperemic, arterial or venous conditioned. CONCLUSIONS: Physical examination and modern imaging can detect the underlying reasons in a quick and reliable way.

Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases.

Complete resection with conservation of cranial nerves is the primary goal of contemporary surgery for glomus jugulare tumors. This publication reports the value of combined surgical approaches in achieving this goal in 12 patients with extensive tumors. Eleven of these tumors were classified as Fisch Class C and/or D, while eight were categorized as Jackson-Glasscock Grade III or IV. Intracranial (intradural) extension was present in 10 patients; four patients had tumor extension into the clivus and two into the cavernous sinus. The petrous internal carotid artery (ICA) was involved in eight and the vertebral artery (VA) in one. Subtemporal-infratemporal, retrosigmoid, and/or extreme lateral transcondylar approaches were added to the usual transtemporal-infratemporal approach. This improved the exposure, provided early control of the petrous ICA, and facilitated tumor removal from the clivus, cavernous sinus, posterior fossa, and foramen magnum, allowing a single-stage resection in eight patients. Ten patients had a complete microscopic resection with no mortality. The facial nerve was preserved in nine cases, with tumor involvement requiring nerve resection followed by grafting in the remaining three. Mobilization of the facial nerve was avoided in five cases; of these, three had intact function and two had House-Brackmann Grade III function on follow-up review. Only one patient had a mild persistent swallowing difficulty. The ICA was preserved in 10 patients and resected in two, while the VA required reconstruction in one case. There were no instances of stroke, and blood transfusions were required in five patients who had tumors with nonembolizable ICA or VA feeders. While complete resection provides the best possibility for cure, the important role of adjuvant radiation therapy in cases with residual tumor is discussed. The importance of degrees of brain-stem compression and vascular encasement is emphasized in classifying the more extensive tumors.

Conservation surgery for glomus jugulare tumors: the value of early diagnosis.

The results of lateral cranial base surgery for glomus jugulare tumors are gratifying when normal anatomy and function can be preserved. The goal of conservation surgery is to preserve normal ear anatomy and cranial nerve function. In general, conservation surgery is tumor-size dependent. Thus, excellent states of functional recovery depend upon accurate early diagnosis. This paper reviews the technical aspects of transtemporal conservation skull base tumor surgery while also reviewing our experience with nearly 100 glomus jugulare patients. Adjuvants to early diagnosis will be highlighted from a review of presenting symptoms, clinical signs, and related diagnosis. Our objective is to provoke a high index of suspicion in physicians charged with the responsibility of diagnosing these tumors. Diagnostic guidelines are proposed.

Phonocephalography: a simple, low-cost non-invasive diagnostic technique. Continued data reporting.

This article presents the phonocephalographic data reported in one case of glomus jugulare tumour, representing local haemodynamic disturbances; and one case with an aortic lesion with pulsating tinnitus, representing systemic haemodynamic disturbances.

[Anaesthetic problems with glomus tumors of the head and neck (author's transl)]. / Anästhesiologische Probleme bei Glomustumoren des Kopf-Hals-Gebietes.

Anaesthesia and Postanaesthetic Course of Three Cases of Glomus Jugulare Tumor Were Studied. Pathophysiology and clinical features of this very rare tumor is discussed on a brief review of literature. After all localisation and dimension of this tumor can cause serious complications during operation and postoperative period. It must be considered that a safe operative and postoperative period is implied by carefull preoperative diagnostic management, special anaesthetic technics like controlled hypotension as well as postoperative intensive care.

Transcatheter embolization of brain arteriovenous malformations and meningiomas. Evoked responses correlations.

Transcatheter embolization of selective arteries of the carotid and vertebral systems were performed in several patients with brain arteriovenous malformations, angiomas and chemodectomas. All patients were submitted to angiography and electrophysiological examination consisting of a conventional EEG and of visual, auditory and somatosensory evoked responses before and after embolization. Patients with tumors showed a marked decrease of blood flow and tumoral necrosis after embolization, facilitating subsequent surgical procedures. Most patients showed an electrophysiological improvement after embolization, in those regions in which angiography revealed brain decompression resulting from the size reduction of the abnormal tissue. Transcatheter embolization can be very useful in the treatment of brain arteriovenous malformations and intracranial tumors, often facilitating surgical procedures.

Collateral circulation in a tumor of the glomus jugulare.

The main anastomotic collaterals between intrathecal and extracranial arteries are shown in a tumor of the glomus jugulare. The significance of these collaterals in embolization therapy is pointed out.

[The blood vessels of the posterior cranial fossa. anatomy, pathophysiology, clinic--a survey (author's transl)]. / Die Gefäbe der hinteren Schädelgrube. Anatomie, pathophysiologie, Klinik--eine Ubersicht.

Pathophysiology and tomography of the blood vessels of the posterior cranial fossa gain clinical interest in treatment of diseases of the inner ear, complications of middle ear inflammations, tumors of the pyramid and cerebello-pontine angle. Numerous variations in the arterial venous system restrict neuroradiological procedures. Techniques to treat a thrombosis of the sinuses were developed 50 years ago. Surgical procedures to remove glomus tumors of the pyramid could be improved by new anatomical and surgical experiences. Unilateral neck dissection occasionally alters the blood flow in the sinuses of the posterior cranial fossa causing serious complications.

[Jugular and tympanic glomus tumors with intracranial growth]. / Opukhol' iaremnogo i barabannogo glomusov s vnutricherepnym rostom.

The authors studied 9 patients with an intracranial growth of a glome tumour. Clinically it was characterized by tumorous symptoms of the middle ear or of the jugular fossa. These signs were accompanied by a cerebral hypertensive syndrome and by symptoms related to the influence of the tumour on the brain stem, cerebellum and III--IV cranial nerves. Radiotherapy was performed in 7 cases and combined therapy in 2 cases. Clinical remission in 2 patients following radiotherapy was seen during II and 3 years. After combined therapy 2 patients (during 9 and 1 year) did not demonstrate any clinical signs of tumour growth. Three patients died due to persistent growth. The fate of 2 patients is unknown.

Noradrenaline-secreting glomus jugulare tumor with cyclic change of blood pressure.

A glomus jugulare tumor secreted a large quantity of noradrenaline (NA) and produced symptoms of tinnitus, palpitation, sweating, and labile hypertension. The NA content of the tumor was 0.75 mg/gm of tissue. Electron microscopical study of the tumor demonstrated many membrane-limited osmiophilic granules. This indicates the capacity of the tumor not only to synthesize but also to store NA in the tumor. Continuous blood pressure recording showed a cyclic change of blood pressure with a cycle length of 10 to 17 minutes that terminated after intravenous doses of phentolamine (0.1 mg/kg) or diazoxide (4.5 mg/kg) and surgical removal of the tumor.