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J Neurol Surg B Skull Base 2012; 73(03): 197-207
DOI: 10.1055/s-0032-1312707
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Management of Giant Transdural Glomus Jugulare Tumors with Cerebellar and Brainstem Compression

Matthew L. Carlson
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Colin L. W. Driscoll
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Joaquin J. Garcia
3   Department of Laboratory Medicine and Pathology, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Jeffrey R. Janus
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Michael J. Link
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
› Author Affiliations
Further Information

Publication History

24 August 2010

23 February 2011

Publication Date:
17 May 2012 (online)

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Abstract

Objective The objective of this study is to discuss the management of advanced glomus jugulare tumors (GJTs) presenting with intradural disease and concurrent brainstem compression.

Study Design This is a retrospective case series.

Results Over the last decade, four patients presented to our institution with large (Fisch D2; Glasscock-Jackson 4) primary or recurrent GJTs resulting in brainstem compression of varying severities. All patients underwent surgical resection through a transtemporal, transcervical approach resulting in adequate brainstem decompression; the average operative time was 12.75 hours and the estimated blood loss was 2.7 L. All four patients received postoperative adjuvant radiotherapy in the form of intensity-modulated radiation therapy or stereotactic radiosurgery. Combined modality treatment permitted tumor control in all patients (range of follow-up 5 to 9 years).

Conclusion A small subset of GJTs may present with intracranial transdural extension with aggressive brainstem compression mandating surgical intervention. Surgical resection is extremely challenging; the surgical team must be prepared for extensive operating time and the patient for prolonged aggressive rehabilitation. Newly diagnosed and recurrent large GJTs involving the brainstem may be controlled with a combination of aggressive surgical resection and postoperative radiation.

Keywords

glomus jugulare - paraganglioma - lateral skull base
 

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