Jugular paraganglioma treatment at the UMC Maribor
Abstract
Background: Jugular paragangliomas are rare, almost exclusively benign and slowly growing tumors. Arising from the cells of paraganglia in jugular bulb, they infiltrate the temporal bone and later grow intracranially. Because of insidious onset, their diagnosis is relatively late. Patients at presentation usually complain of pulsatile tinnitus and hearing loss, lasting for years. Also common are palsies of the cranial nerves in the area of tumor growth – i.e., facial, glossopharyngeal, vagal, accessory and hypoglossal nerves. Surgical resection is the standard treatment, though technically demanding because of difficult approach to the lateral cranial base and vital structures in the area. The team for treating such patients comprises an ENT specialist, interventional radiologist and a neurosurgeon. The purpose of this article is to review clinical experiences with the treatment of jugular paragangliomas at our Department of ENT and Maxillofacial Surgery of the University Medical Centre Maribor.
Methods: We reviewed the documentation of ten patients treated for jugular paraganglioma in the last 15 years, and presented the clinical data in a table.
Results: Nine patients were treated by preoperative embolization and surgical resection. Surgery was contraindicated in one patient with highly dominant venous drainage on the side of the tumor and aplastic transverse sinus on the opposite side. She was treated by primary radiotherapy. One patient with intracranial tumor growth was treated by subtotal resection and adjuvant radiotherapy. At presentation, lower cranial nerve palsies were present in 60 % of our patients. With the other 40 % we managed to preserve the nerve function postoperatively. Facial nerve function practically normalized in all patients with anterior transposition of the nerve. Our patients were provided with postoperative rehabilitation and corrective procedures such as vocal cord medialization and BAHA hearing aid implantation.
Discussion: Despite the risks, the surgical treatment is effective in halting the disease and preserving cranial nerve function. The results of our work demonstrate that our patients are provided with a thorough and comprehensive care.
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References
Carlson ML, Sweeney AD, Wanna GB, Netterville JL, Haynes DS. Natural History of Glomus Jugulare: A Review of 16 Tumors Managed with Primary Observation. Otolaryngol Head Neck Surg. 2015;152(1):98-105.
Sokabe A, Mizooka M, Sakemi R, Kobayashi T, Kishikawa N, Yokobayashi K, et al. Systemic Inflammatory Syndrome Associated with a Case of Jugular Paraganglioma. Intern Med. 2016;55(15):2105-8.
Pellitteri P. Paragangliomas of the head and neck. Oral Oncol. 2004;40(6):563-75.
Capatina C, Ntali G, Karavitaki N, Grossman AB. The management of head-and-neck paragangliomas. Endocr Relat Cancer. 2013;20(5):R291-305.
Gulya AJ. The glomus tumor and its biology. Laryngoscope. 1993;103(11 Pt 2 Suppl 60):7–15.
Myssiorek D. Head and neck paragangliomas: an overview. Otolaryngol Clin North Am. 2001;34(5):829–36.
Forbes JA, Brock AA, Ghiassi M, Tompson RC, Haynes DS, Tsai BS. Jugulotympanic paragangliomas: 75 years of evolution in understanding. Neurosurg Focus. 2012;33(2):E13.
Zak FG, Lawson W. The Paraganglionic Chemoreceptor System. New York, NY: Springer US; 1982 [cited 2017 Jan 14]. Available from: http://link.springer.com/10.1007/978–1-4612–5668–7.
Scheick SM, Morris CG, Amdur RJ, Bova FJ, Friedman WA, Mendenhall WM. Long-term Outcomes After Radiosurgery for Temporal Bone Paragangliomas. Am J Clin Oncol. In press.
Woolen S, Gemmete JJ. Paragangliomas of the Head and Neck. Neuroimaging Clin N Am. 2016;26(2):259-78.
Pham V. Glomus tumors of the temporal bone: Synopsis of glomus tympanicum and jugulare. Department of Otolaryngology The University of Texas Medical Branch (UTMB Health). May 29, 2012. 2012 [cited 2017 Jan 15]. Available from: https://www.utmb.edu/otoref/Grnds/glomus-2012–05–29/4-glomus-2012–0529-B.pdf.
Alford BR, Guilford FR. A comprehensive study of tumors of the glomus jugulare. Laryngoscope. 1962;72:765–805.
Wanna GB, Sweeney AD, Haynes DS, Carlson ML. Contemporary Management of Jugular Paragangliomas. Otolaryngol Clin North Am. 2015;48(2):331–41.
Marsh M, Jenkins HA. Temporal Bone Neoplasms and Lateral Cranial Base Surgery. In: Cummings Otolaryngology. 6th ed. Philadelphia, PA: Elsevier/Saunders; 2015 [cited 2017 Jan 14]. p. 2719–2747.e5. Available from: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9781455746965001767.
Odat H, Shin S-H, Odat MA, Alzoubi F. Facial nerve management in jugular paraganglioma surgery: a literature review. J Laryngol Otol. 2016;130(03):219–24.
Gjuric M, Seidinger L, Wigand ME. Long-term results of surgery for temporal bone paraganglioma. Skull Base Surg. 1996;6(3):147–52.
Fayad JN, Keles B, Brackmann DE. Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol. 2010;31(2):299–305.
Abud DG, Mounayer C, Benndorf G, Piotin M, Spelle L, Moret J. Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas. AJNR Am J Neuroradiol. 2004;25(9):1457-62.
LaMuraglia GM, Fabian RL, Brewster DC, Pile-Spellman J, Darling RC, Cambria RP, et al. The current surgical management of carotid body paragangliomas. J Vasc Surg. 1992;15(6):1038-44; discussion 1044-5.
Miller RB, Boon MS, Atkins JP, Lowry LD. Vagal paraganglioma: the Jefferson experience. Otolaryngol Head Neck Surg. 2000;122(4):482-7.
Ungkanont K, Byers RM, Weber RS, Callender DL, Wolf PF, Goepfert H. Juvenile nasopharyngeal angiofbroma: an update of therapeutic management. Head Neck. 1996;18(1):60-6.
Sheehan JP, Tanaka S, Link MJ, Pollock BE, Kondziolka D, Mathieu D, et al. Gamma Knife surgery for the management of glomus tumors: a multicenter study: Clinical article. J Neurosurg. 2012;117(2):246-54.
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