Clin Exp Otorhinolaryngol.  2009 Mar;2(1):28-32. 10.3342/ceo.2009.2.1.28.

Clinical Presentation and Management of Jugular Foramen Paraganglioma

• Chung SM
• Kim HS
• Jung J
• Lee HK
• Lee WS

• KMID: 1466560
• DOI: http://doi.org/10.3342/ceo.2009.2.1.28

Abstract

OBJECTIVES
Jugular foramen paraganglioma is a locally invasive, benign tumor, which grow slowly and causes various symptoms such as pulsatile tinnitus and low cranial nerve palsy. Complete surgical resection is regarded as the ideal management of these tumors. The goal of this study is to identify the clinical characteristics and most effective surgical approach for jugular foramen paraganglioma.
METHODS
Retrospective analysis of 9 jugular foramen paraganglioma patients who underwent surgical resection between 1986 and 2005 was performed. Clinical records were reviewed for analysis of initial clinical symptoms and signs, audiological examinations, neurological deficits, radiological features, surgical approaches, extent of resection, treatment outcomes and complications.
RESULTS
Most common initial symptom was hoarseness, followed by pulsatile tinnitus. Seven out of 9 patients had at least one low cranial nerve palsy. Seven patients were classified as Fisch Type C tumor and remaining 2 as Fisch Type D tumor on radiologic examination. Total of 11 operations took place in 9 patients. Total resection was achieved in 6 cases, when partial resection was done in 3 cases. Two patients with partial resection received gamma knife radiosurgery (GKS), when remaining 1 case received both GKS and two times of revision operation. No mortality was encountered and there were few postoperative complications.
CONCLUSION
Neurologic examination of low cranial nerve palsy is crucial since most patients had at least one low cranial nerve palsy. All tumors were detected in advanced stage due to slow growing nature and lack of symptom. Angiography with embolization is crucial for successful tumor removal without massive bleeding. Infratemporal fossa approach can be considered as a safe, satisfactory approach for removal of jugular foramen paragangliomas. In tumors with intracranial extension, combined approach is recommended in that it provides better surgical view and can maintain the compliance of the patients.

Keyword

Jugular foramen paraganglioma; Infratemporal approach; Intracranial extension; Combined approach

MeSH Terms

Angiography
Compliance
Cranial Nerve Diseases
Hemorrhage
Hoarseness
Humans
Hypogonadism
Mitochondrial Diseases
Neurologic Examination
Ophthalmoplegia
Paraganglioma
Postoperative Complications
Radiosurgery
Retrospective Studies
Tinnitus
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

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  Fig. 1 Type C Glomus jugulare tumor (Patient 6), arising from right jugular foramen and extending into right mastoid cavity and infralabyrinthe.

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  Fig. 2 Type D Glomus jugulare tumor (Patient 5) showing intracranial extension, compressing pons and brainstem.

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  Fig. 3 Angiography showing ascending pharyngeal artery as tumor feeding vessel.

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