Glomus Jugulare Tumors With Intracranial Extension

Abstract and Introduction

Abstract

Glomus tumors provide unique surgical challenges for both tumor resection and defect reconstruction. Tumors with intracranial extension compound these challenges. Surgical techniques have evolved, and now, with a multidisciplinary team, single-stage surgeries are the standard. In this paper the authors will report the results of the Otology Group protocol for surgical management of glomus tumors with intracranial extension. Particular attention will be paid to prevention of cerebrospinal fluid leaks with the use of vascularized tissue for defect reconstruction.

Introduction

Glomus tumors are the second most common neurootological tumor after acoustic neuromas. The surgical management of these tumors has evolved in conjunction with the evolution of the specialty of skull base surgery. Microsurgical equipment and techniques have developed to the point where the question of surgical resectability is rarely an issue. Imaging technology has also improved and preoperative planning is sophisticated and exact. Nonetheless, neurootological skull base surgery for the resection of glomus jugulare tumors is not without risk and morbidity.

Glomus jugulare tumors arise in the lateral skull base and grow along the paths of least resistance (Fig. 1). They often will develop intracranial extension. They can gain access into the subarachnoid space by penetrating the dura of the posterior fossa, growing along cranial nerves (Fig. 2).^[7] They can also, less commonly, penetrate the dura of the middle fossa. Their involvement with major vessels, proximity to cranial nerves, and their propensity for intracranial extension can result in significant morbidity from tumor resection. Kinney^[9] recommended a two-stage resection of glomus jugulare tumors with intracranial ex tension. He suggested that the intracranial component be removed first. Jenkins and Fisch^[8] recommended staged resection of tumors that have a 2-cm or greater intracranial extension. Jackson, et al.,^[7] showed that a single-stage resection and reconstruction offered the greatest likelihood of complete tumor removal while preserving local tissue for use in reconstruction.

(Enlarge Image)

Figure 1.

Extent of glomus tumor is highly variable along lines of least resistance.

(Enlarge Image)

Figure 2.

Intracranial extension is seen when tumor enters into the subarachnoid space directly through dura or along cranial nerves.

Glomus jugulare tumors with intracranial extension have posed great surgical and reconstruction challenges. These challenges have, in turn, led to the development of innovative surgical solutions. Glomus jugulare tumors grow in a manner that is highly variable from patient to patient. The variability of tumor presentation has necessitated the development of a creative multidisciplinary approach to manage these complicated lesions. In this report we will discuss the single-stage surgical and reconstructive management of glomus jugulare tumors that have intracranial extension.