Microsurgical Resection of Multiple Giant Glomus Tumors

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dc.contributor.authorCeccato G.H.W.
dc.contributor.authorRassi M.S.
dc.contributor.authorBorba L.A.B.
dc.date.accessioned2024-03-12T23:54:44Z
dc.date.available2024-03-12T23:54:44Z
dc.date.issued2019
dc.description.abstract© 2019 Georg Thieme Verlag KG Stuttgart • New York.Glomus tumors, also called paragangliomas, are challenging lesions, demanding accurate knowledge of complex anatomy and pertinent approaches. We present the case of a 39-year-old male presenting with headache, vertigo, tinnitus, hearing loss, and hoarseness. Neurological assessment showed facial paralysis House-Brackmann IV and lower cranial nerves deficits. Preoperative magnetic resonance imaging (MRI) demonstrated two large lesions, suggestive of a glomus jugulare, and carotid body paragangliomas. Considering worsening of the symptoms and the important mass effect of both lesions over the neurovascular structures, microsurgical excision was offered, after preoperative tumor embolization. We preferred to approach both lesions in the same operation, starting by the cervical tumor. Initially there was not an easily identifiable dissection plane between the tumor and the carotid artery, but it was achieved after performing a subadventitial dissection, being possible to resect the entire lesion. The jugular foramen lesion was approached through a postauricular transtemporal approach, skeletonizing the sigmoid sinus, jugular bulb, and facial nerve, following a complete mastoidectomy. The tumor, extending to the intradural compartment, middle ear, internal auditory canal, petrous internal carotid artery, and internal jugular vein was completely removed. Postoperative MRI demonstrated complete resection of both lesions, and pathology confirmed to be paragangliomas. In the immediate postoperative period, the facial paralysis evolved to House-Brackmann grade VI, improving to grade III during follow-up. The patient underwent a vocal cord medialization in order to improve voice quality and swallowing. These are challenging lesions and extensive laboratory training is mandatory to be familiarized with the regional anatomy and its various surgical approaches.
dc.description.firstpageS385
dc.description.lastpageS388
dc.description.volume80
dc.identifier.doi10.1055/s-0039-1695055
dc.identifier.issn2193-6331
dc.identifier.urihttps://dspace.mackenzie.br/handle/10899/35351
dc.relation.ispartofJournal of Neurological Surgery, Part B: Skull Base
dc.rightsAcesso Aberto
dc.subject.otherlanguagecarotid body
dc.subject.otherlanguageglomus tumor
dc.subject.otherlanguagejugular foramen
dc.subject.otherlanguageparaganglioma
dc.subject.otherlanguagetranstemporal
dc.titleMicrosurgical Resection of Multiple Giant Glomus Tumors
dc.typeArtigo
local.scopus.citations4
local.scopus.eid2-s2.0-85075400178
local.scopus.updated2024-05-01
local.scopus.urlhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85075400178&origin=inward
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