CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 04): S385-S388
DOI: 10.1055/s-0039-1695055
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Microsurgical Resection of Multiple Giant Glomus Tumors

Guilherme H. W. Ceccato
1  School of Medicine, Federal University of Paraná, Curitiba, PR, Brazil
,
Marcio S. Rassi
2  Department of Neurosurgery, A.C. Camargo Cancer Center, São Paulo, Brazil
,
Luis A. B. Borba
3  Department of Neurosurgery, Evangelic University Hospital of Curitiba, PR, Brazil
4  Department of Neurosurgery, Federal University of Paraná, Curitiba, PR, Brazil
› Author Affiliations
Further Information

Publication History

01 April 2019

07 July 2019

Publication Date:
03 October 2019 (online)

Abstract

Glomus tumors, also called paragangliomas, are challenging lesions, demanding accurate knowledge of complex anatomy and pertinent approaches. We present the case of a 39-year-old male presenting with headache, vertigo, tinnitus, hearing loss, and hoarseness. Neurological assessment showed facial paralysis House–Brackmann IV and lower cranial nerves deficits. Preoperative magnetic resonance imaging (MRI) demonstrated two large lesions, suggestive of a glomus jugulare, and carotid body paragangliomas. Considering worsening of the symptoms and the important mass effect of both lesions over the neurovascular structures, microsurgical excision was offered, after preoperative tumor embolization. We preferred to approach both lesions in the same operation, starting by the cervical tumor. Initially there was not an easily identifiable dissection plane between the tumor and the carotid artery, but it was achieved after performing a subadventitial dissection, being possible to resect the entire lesion. The jugular foramen lesion was approached through a postauricular transtemporal approach, skeletonizing the sigmoid sinus, jugular bulb, and facial nerve, following a complete mastoidectomy. The tumor, extending to the intradural compartment, middle ear, internal auditory canal, petrous internal carotid artery, and internal jugular vein was completely removed. Postoperative MRI demonstrated complete resection of both lesions, and pathology confirmed to be paragangliomas. In the immediate postoperative period, the facial paralysis evolved to House–Brackmann grade VI, improving to grade III during follow-up. The patient underwent a vocal cord medialization in order to improve voice quality and swallowing. These are challenging lesions and extensive laboratory training is mandatory to be familiarized with the regional anatomy and its various surgical approaches.

The link to the video can be found at: https://youtu.be/gA_ckwFq_9c.

Disclosure statement

All authors contributed to this article and attest to no conflicts of interest. All authors have no financial disclosures.


Patient Consent Statement

Informed consent was obtained from the patient for publication of this operative video.