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The incidence of glomus jugulare tumor has been cited as 1 per 1. They affect females more commonly than males at a 3: 1 ratio and present in the fifth and sixth decades of life.
One to three percent of glomus tumors are functioning paragangliomas and secrete catecholamines, causing hypertension, palpitations, and headaches. Herein we present a classic case of a GJT and a practical approach to identifying and managing this condition.
These symptoms were associated with aural fullness, intermittent racing heartbeat, and a positional globus sensation.
Otoscopic examination revealed an intact tympanic membrane, but a retrotympanic cherry-red bulge was seen in the posterior-inferior quadrant.
Her contralateral ear was unremarkable. Further cardiovascular maneuvers revealed improvement in tinnitus volume with compression of the right neck.
Her cranial nerve exam was within normal limits. An audiogram and radiographic images were ordered and highly suggestive of a GJT.
The audiogram showed mixed conductive and sensorineural hearing loss of the right ear, with mild sensorineural hearing loss of the left ear. Computed tomography CT revealed an 8 x 12 x 23 mm homogenous mass in the right jugular foramen Figure 1-2, confirmed by magnetic resonance imaging MRI to be a glomus jugulare tumor, extending from the jugular bulb, along the lower cranial nerves, invading the carotid canal, and surrounding the vertical segment of the petrous carotid artery.
The tumor was therefore staged as a Fisch type C 2 glomus jugulare tumor Figure 3. The magnetic resonance angiography MRA revealed tortuous branches of the right external carotid artery feeding the tumor Figure 4.
Following diagnosis and staging, radiation was recommended, either fractionated radiation therapy or radiosurgery, due to the size and location of the tumor adjacent to the carotid artery and internal jugular vein with high risk of morbidity from surgical intervention.
Surgical resection of this tumor would have required, at least a Fisch type A infratemporal fossa approach and would have carried a high risk of lower cranial nerve injury, as well as facial nerve injury, in a patient with no preoperative lower cranial nerve deficits.
Due to the small tumor volume, radiosurgery would be an appropriate primary treatment option to control tumor growth and improve clinical outcomes.
They typically expand within the temporal bone via the path of least resistance, first eroding the jugular fossa, and then the posteroinferior petrous bone.