Glomus Jugulare Surgical Management, A case report

Abstract

Glomus jugulare are slow growing paragangliomas arising in the jugular foramen and localised in the jugular fossa in the temporal bone. They are benign lesions originating from neural crest precursors known as Para ganglia. However they can cause significant mass effect and erode into local structures leading to significant morbidity. Their management is fraught with challenges because of their high vascularity, difficult anatomic location and advanced stage at diagnosis. Apart from observation, surgery and stereotactic radiotherapy have been deployed in the management of these lesions.  The surgical management can employ various maneuvers in a bid to access the whole tumour mass as onco-functional balance is maintained in these patients. We present a case summary of a 44 year old gentleman with right sided pulsatile tinnitus  and hearing loss for 3 yrs. Glomus jugulare Fisch grade C1 was diagnosed and managed by  a multidisciplinary team via a sub-temporal approach with anterior transposition of the  facial nerve. Preoperative embolisation of the tumour was done 24 hours prior to the operation. A post-operative House Brackman 1 facial nerve palsy occured but the patient is expected  to improve with follow up. Surgical management has been bolstered by improved imaging, microsurgical skills, and  preoperative adjuncts in a bid to maintain optimal oncofunctional balance.