Glomus Jugulare Tumor Presentation and Management: A Case Study

Mark C. Coles

Disclosures

J Neurosci Nurs. 2004;36(4) 

In This Article

Postoperative Course

Due to the extensive surgical time (greater than 8 hours), 400-cc blood loss, and edema, the patient was kept sedated and intubated overnight. Nursing measures included maintaining the head of the bed at 30 degrees, keeping the head in neutral position, with hourly neurological vital sign checks and continuous arterial blood pressure monitoring. Following extubation, she was alert and moving all extremities. The patient rated headache and incisional pain as 4/10, well controlled with dilaudid 1mg intravenous (IV) q 1-2 hr prn. She had mild ataxia, increased hearing loss on the left, mildly worsened dysphagia, and a partial facial palsy. Although the facial nerve had been undisturbed, it was postulated that heat transference from the extensive surgical burr use may have contributed to the deficit. Tracheotomy was not required. Should a tracheotomy be deemed necessary, however, it is important for nursing staff to be aware that cerebral venous return is frequently affected with resection of glomus jugulare tumors. Compromise of the contralateral jugular vein should be avoided if ipsilateral drainage is impeded or absent due to tumor or surgical ligation. Therefore, nursing measures include head positioning maintaining neutral alignment and avoiding use of tight tracheotomy ties. Any signs of increasing intracranial pressure (ICP) may be related to compromise of the jugular venous return.

The patient was kept NPO until speech therapy was consulted and swallowing studies obtained. A temporary feeding tube was removed on postoperative day 5 and the patient advanced to a pureed diet. Dexamethasone, begun during surgery, was maintained for a week and then gradually tapered. Rehabilitation included speech/swallowing therapy, gait training, plus treatment directed towards maximizing facial nerve recovery including electrical stimulation, massage, and facial exercises. She had gradual improvement in all areas and was transferred to inpatient rehabilitation on day 6 and discharged to home with outpatient rehabilitation on day 9. By the first office visit 4 weeks after surgery, the patient demonstrated improvement of the facial palsy, had returned to near preoperative level of dysphagia, and had minimal ataxia. Continued gradual lessening of all deficits is expected. Repeat MRI demonstrated no evidence of tumor recurrence. The MRI will be repeated annually for the next few years.

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