Laryngorhinootologie 2016; 95(12): 843-848
DOI: 10.1055/s-0042-105214
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Interdisziplinäres Management von komplexen tympanojugulären Paragangliomen Fisch Typ C und D

Management of Complex Tympanojugular Paragangliomas
A. Harati
1   Neurosurgical department, Klinikum Dortmund, Dortmund
,
R. Schultheiß
1   Neurosurgical department, Klinikum Dortmund, Dortmund
,
K. Harati
2   Department of Plastic Surgery, Bergmannsheil Bochum, Bochum
,
S. Rohde
3   Department of Radiology, Klinikum Dortmund, Dortmund
,
W. Weber
4   Department of Radiology, Knappschaftskrankenhaus Bochum-Langendreer, Bochum
,
T. Deitmer
5   HNO-Klinik, Klinikum Dortmund, Dortmund
› Author Affiliations
Further Information

Publication History

eingereicht 07 October 2015

akzeptiert 14 March 2016

Publication Date:
29 June 2016 (online)

Zusammenfassung

Hintergrund: Tympanojuguläre Paragangliome (TJP) sind benigne gefäßreiche Tumore, die lokal destruktiv wachsen. Trotz der umfangreichen Literatur sind die Behandlungskonzepte speziell bei ausgedehnten TJP nach wie vor umstritten. In der vorliegenden Studie präsentieren wir das interdisziplinäre Management von komplexen TJP.

Material und Methoden: Zwischen 2003 und 2013 wurden insgesamt 17 Patienten mit TJP Fisch Typ C und Typ D durch die Arbeitsgruppe Schädelbasischirurgie am Klinikum Dortmund behandelt. Primärsymptome waren am häufigsten eine Hörminderung, gefolgt von Fazialisparese bzw. kaudaler Hirnnervenläsion. 2 Patienten stellten sich mit einem Rezidivtumor vor. Eine interdisziplinäre mikrochirurgische Tumorresektion über einen retro/infralabyrinthischen Zugang nach vorheriger endovaskulärer Tumorembolisation erfolgte bei 14 Patienten, bei 2 weiteren Patienten erfolgte eine Strahlentherapie.

Ergebnisse: Eine radikale Tumorresektion konnte bei 10 Patienten erreicht werden. Eine temporäre postoperative Fazialisparese trat bei 2 Patienten auf und eine dauerhafte Stimmbandparese bei 3 Patienten. Ein Tumor-Rezidiv trat bei einem Patienten auf. Durch die primäre Strahlentherapie konnte bei 2 Patienten kein Tumorprogress festgestellt werden. Das Outcome des Gesamtkollektivs auf der Basis des Karnofsky-Index betrug bei 12 Patienten 100%, bei den übrigen 5 Patienten betrug er 90%.

Diskussion: Die operative Entfernung von TJP nach vorheriger Embolisation ist das Therapieverfahren 1.Wahl. Bei älteren bzw. multimorbiden Patienten ist die primäre Strahlentherapie eine geeignete Therapieoption und mit einer hohen Tumorkontrollrate assoziiert. Eine präoperative Abklärung mit individueller Risiko-Nutzen-Abwägung sind für den Therapierfolg entscheidend.

Abstract

Background: Tympanojugular paraganglioma (TJP) are benign, high vascularized, local destructive tumors. Despite many studies in the literature, the management of particularly complex TJP (e. g., posterior fossa and/or carotid artery invasion) remains controversial. In the current study we present our treatment strategies for complex TJP and long-term results.

Patients and methods: Between 2003 and 2013, 17 patients with TJP Fisch types C and D were treated in our institution. Primary symptoms were hearing loss, followed by facial nerve palsy and lower cranial nerve impairments. 2 patients presented with recurrent tumors. Surgical treatment after endovascular tumor embolization was performed in 14 patients. 2 patients were treated by radiation therapy.

Results: Gross tumor resection was achieved in 10 patients. A temporary postoperative facial nerve palsy occurred in 2 patients and permanent postoperative vocal cord palsy in 3 patients. During long term follow-up, one patient experienced regrowth of the residual tumor. No tumor progress was observed in both patients treated with radiation therapy. Outcome assessed by Karnofsky scale showed 100% functionality in 12 patients and 90% in 5 patients.

Discussion: Surgical treatment of TJP after endovascular embolization is the treatment of choice in young and healthy patients. In older patients with premorbid conditions, radiation therapy is the main treatment option and is associated with high tumor control rates. Precise preoperative staging together with individualize risk-benefit assessment and interdisciplinary treatment strategy are essential for a favorable outcome.

 
  • Literatur

  • 1 Boedeker CC, Ridder GJ, Schipper J. Paragangliomas of the head and neck: diagnosis and treatment. Fam Cancer 2005; 4: 55-59
  • 2 Offergeld C, Brase C, Yaremchuk S et al. Head and neck paragangliomas: clinical and molecular genetic classification. Clinics (Sao Paulo) 2012; 67 (Suppl. 01) 19-28
  • 3 Oldring D, Fisch U. Glomus tumors of the temporal region: surgical therapy. Am J Otol 1979; 1: 7-18
  • 4 Gerosa M, Visca A, Rizzo P et al. Glomus jugulare tumors: the option of gamma knife radiosurgery. Neurosurgery 2006; 59: 561-569
  • 5 Capatina C, Ntali G, Karavitaki N et al. The management of head-and-neck paragangliomas. Endocr Relat Cancer 2013; 20: R291-R305
  • 6 Boedeker CC, Neumann HPH, Maier W et al. Malignant head and neck paragangliomas in SDHB mutation carriers. Otolaryngol Head Neck Surg 2007; 137: 126-129
  • 7 Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 2002; 97: 1356-1366
  • 8 Blumenfeld JD, Cohen N, Laragh JH et al. Hypertension and catecholamine biosynthesis associated with a glomus jugulare tumor. N Engl J Med 1992; 327: 894-895
  • 9 Schwaber MK, Glasscock ME, Nissen AJ et al. Diagnosis and management of catecholamine secreting glomus tumors. Laryngoscope 1984; 94: 1008-1015
  • 10 Liu JK, Sameshima T, Gottfried ON et al. The combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach for resection of glomus jugulare tumors. Neurosurgery 2006; 59: ONS115-ONS125
  • 11 Hofmann E, Behr R, Neumann-Haefelin T et al. Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int 2013; 110: 451-458
  • 12 Carlson ML, Driscoll CLW, Garcia JJ et al. Surgical management of giant transdural glomus jugulare tumors with cerebellar and brainstem compression. J Neurol Surg B Skull Base 2012; 73: 197-207
  • 13 Yoshida K, Katayama M, Kuroshima Y et al. Glomus jugulare tumor presenting with intracerebellar hemorrhage. Skull Base Surg 2000; 10: 101-105
  • 14 Suárez C, Rodrigo JP, Bödeker CC et al. Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy. Head Neck 2013; 35: 1195-204
  • 15 Guss ZD, Batra S, Limb CJ et al. Radiosurgery of glomus jugulare tumors: a meta-analysis. Int J Radiat Oncol Biol Phys 2011; 81: e497-e502
  • 16 Briner HR, Linder TE, Pauw B et al. Long-term results of surgery for temporal bone paragangliomas. Laryngoscope 1999; 109: 577-583
  • 17 Harati A, Deitmer T, Rohde S et al. Microsurgical treatment of large and giant tympanojugular paragangliomas. Surg Neurol Int 2014; 5: 179
  • 18 Forbes JA, Brock AA, Ghiassi M et al. Jugulotympanic paragangliomas: 75 years of evolution in understanding. Neurosurg Focus 2012; 33: E13
  • 19 van der Mey AG, Frijns JH, Cornelisse CJ et al. Does intervention improve the natural course of glomus tumors? A series of 108 patients seen in a 32-year period. Ann Otol Rhinol Laryngol 1992; 101: 635-642
  • 20 Jansen JC, van den Berg R, Kuiper A et al. Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal. Cancer 2000; 88: 2811-2816
  • 21 Gilbo P, Morris CG, Amdur RJ et al. Radiotherapy for benign head and neck paragangliomas: a 45-year experience. Cancer 2014; 120: 3738-3743
  • 22 Bitaraf MA, Alikhani M, Tahsili-Fahadan P et al. Radiosurgery for glomus jugulare tumors: experience treating 16 patients in Iran. J Neurosurg 2006; 105 Suppl 168-174
  • 23 Genç A, Bicer A, Abacioglu U et al. Gamma knife radiosurgery for the treatment of glomus jugulare tumors. J Neurooncol 2010; 97: 101-108
  • 24 Ivan ME, Sughrue ME, Clark AJ et al. A meta-analysis of tumor control rates and treatment-related morbidity for patients with glomus jugulare tumors. J Neurosurg.
  • 25 Cole JM, Beiler D. Long-term results of treatment for glomus jugulare and glomus vagale tumors with radiotherapy. Laryngoscope 1994; 104: 1461-5
  • 26 Wong BJ, Roos DE, Borg MF. Glomus jugulare tumours: A 15year radiotherapy experience in South Australia. J Clin Neurosci 2014; 21: 456-461
  • 27 Makiese O, Chibbaro S, Marsella M et al. Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases. Neurosurg Rev 2012; 35: 185-194
  • 28 Sanna M, Jain Y, De Donato G et al. Management of jugular paragangliomas: the Gruppo Otologico experience. Otol Neurotol 2004; 25: 797-804
  • 29 White JB, Link MJ, Cloft HJ. Endovascular embolization of paragangliomas: A safe adjuvant to treatment. J Vasc Interv Neurol 2008; 1: 37-41
  • 30 Skrivan J, Zvĕrina E, Kluh J et al. Our experience with surgical treatment of tympanojugular pragangliomas. Prague Med Rep 2010; 111: 25-34
  • 31 Jenkins HA, Fisch U. Glomus tumors of the temporal region. Technique of surgical resection. Arch Otolaryngol 1981; 107: 209-214
  • 32 Rhoton AL. Jugular foramen. Neurosurgery 2000; 47: S267-S285
  • 33 Cinibulak Z, Krauss JK, Nakamura M. Navigated minimally invasive presigmoidal suprabulbar infralabyrinthine approach to the jugular foramen without rerouting of the facial nerve. Neurosurgery 2013; 73: ons3-ons15
  • 34 Sanna M, Shin S-H, De Donato G et al. Management of complex tympanojugular paragangliomas including endovascular intervention. Laryngoscope 2011; 121: 1372-1382
  • 35 Borba LAB, Ale-Bark S, London C. Surgical treatment of glomus jugulare tumors without rerouting of the facial nerve: an infralabyrinthine approach. Neurosurg Focus 2004; 17: E8