Endovascular Approach to Glomus Jugulare Tumors

Abstract

Background: Paragangliomas are benign neuroendocrine tumors derived from the glomus cells of the vegetative nervous system. Typically, they are located in the region of the jugular bulb and middle ear. The optimal management is controversial and can include surgical excision, stereotactic radiosurgery and embolization.

Case report: We report the endovascular approach to three patients harboring glomus jugulare paragangliomas. In all cases incomplete occlusion of the lesions was achieved and recanalization in the follow-up period was revealed. Two patients presented no clinical improvement and the remaining one experienced a transient withdrawal of tinnitus.

Conclusions: It is technically difficult to achieve complete obliteration of glomus jugulare tumors with the use of embolization and the subtotal occlusion poses a high risk of revascularization and is not beneficial in terms of alleviating clinical symptoms.

Keywords: Embolization, Therapeutic; Glomus Jugulare; Glomus Jugulare Tumor; Paraganglioma.

Figure 1

External carotid injection (A) and fluoroscopic working projections (B) show the tumoral blush. On the digital subtraction angiography performed directly after embolization (C) a residual contrast inflow is seen. A control angiogram taken 20 months later revealed significant tumor revascularization (D).

Figure 2

Axial (A) and coronal (B) T1+C magnetic resonance imaging sequences demonstrate a left-sided, homogeneously enhancing glomus jugulare tumor with a maximal diameter of 2.7 cm.

Figure 3

Left external carotid injection (A) presents a jugulo-tympanic paraganglioma tumoral blush. Two-staged embolization was performed with a subtotal effect of vascular occlusion (B). A control angiogram taken 13 months later revealed significant tumor revascularization (C).