Preoperative diagnosis and management of recurring glomus tympanicum and jugulare tumors
23 April 2019 (online)
Angioproliferative tumors of the glomus jugulare and tympanicum are a rare but well-known entity, which manifest as a retrotympanic vascular mass with pulsatile tinnitus and visible pulsation in otomicroscopy.
A diagnostic and pretherapeutic standard approach does exist for primary tumors, but can differ in case of recurrence.
Patients and Methods:
Herein we present three cases of recurring angioproliferative glomus jugulare (2) and tympanicum (1) tumors respectively, which were noticed by the patients themselves through re-appearance of pulsatile tinnitus. To confirm the diagnosis, neuro-otologic assessment as well as tympanometry, high-resolution CT of the petrous bone and digital angiography, and, if applicable, an Angio-MRI with embolization, were performed.
Unlike the clinical aspect, which was almost the same as in primary manifestation, the angiographically confirmed blood supply path differed from the primary manifestation in every individual case. In one case, embolization of the recurrence could not be performed due to the risk of cerebral ischaemia, but digital angiography gave crucial hints for the targeted ligature of supplying vessels during surgery. In every case operative revision succeeded without the need for erythrocyte transfusion.
Recurrent tumors of glomus jugulare and tympanicum can be managed surgically if these cases are meticulously assessed in terms of extent, site, functional impairment and supplying vessels. In this context, the strategic approach to isolate the tumor from its blood supply is key to successful surgical management.