Management of Jugulotympanic Paragangliomas: Our Experience in India

Objective: Jugulotympanic paragangliomas are vascular tumors originating from chemoreceptors situated in the roof of the jugular foramen and on the promontory along the tympanic nerve. This retrospective study shares our experience in the management of these vascular lesions.

Study Design: A retrospective chart review was performed.

Setting: The study was conducted in a tertiary care center.

Subject and Method: Charts of 18 patients with jugulotympanic paraganglioma operated on from 2000–2007 were reviewed. Data regarding clinical presentation, staging of tumor and surgical procedures, management of facial nerve and other cranial nerve deficits, treatment outcomes, postoperative complications, and follow-up results were recorded.

Results: The 18 patients with jugulotympanic paragangliomas were operated on from 2000–2007. Fourteen were glomus jugulare and 4 were glomus tympanicum. Pulsatile tinnitus (17/18) and hearing loss (16/18) were the most common presenting symptoms. Cranial nerve involvement was seen in 13 patients (72%) at the time of presentation. Multiple cranial nerve palsies were observed in 11 (61%) patients. Four patients had type B, 10 had type C, and 4 had type D stage of tumor. Complete surgical removal was possible in 14/18 patients. There was residual tumor in 4 patients (1 posterior fossa and 3 in the pericarotid region).Postoperative improvement was observed in cranial nerve and hearing function.

Conclusion: Complete excision of tumor with preservation of adjoining neurovascular structures is the primary therapeutic option. Facial nerve status can be improved with proper intra- and postoperative procedures, improvement of hearing is possible in selected cases. Rehabilitation of phono pharyngeal functional deficit is an important component of management of glomus tumors.