Skull base surgery for removal of temporal bone tumors

CONCLUSION: When selecting the appropriate surgical approach the pathological type of tumor, the physiological status as well as the functional aspects should be considered. Understanding the strengths and weaknesses of each surgical technique and knowledge of the particular tumor biology facilitates selection of the most appropriate surgical approach and a successful outcome. OBJECTIVES: The purpose of this study was to review cases that underwent skull base surgery for a variety of tumors that involved the temporal bone. We reviewed a single center's 25-year experience for epidemiologic characteristics, symptoms, treatment type and outcomes. PATIENTS AND METHODS: The medical records and radiological images of 91 patients, who underwent skull base surgery, were retrospectively reviewed. RESULTS: Among the 91 patients, 61 cases had benign disease and 30 had malignancies. A facial nerve schwannoma was the most common benign intratemporal tumor and a squamous cell carcinoma was the most common malignant tumor. With the facial nerve schwannoma, facial nerve paralysis and hearing loss were the most common presenting complaints; otalgia was the most common presenting symptom for temporal bone cancer. For patients with a glomus tumor, there was a characteristic pulsating tinnitus. A majority of the facial nerve schwannomas were resectable through the transmastoid approach. The infratemporal fossa approach type A was usually required for lower cranial nerve schwannomas and glomus jugulare tumors. However, the fallopian bridge technique with hypotympanectomy was another surgical option. Partial temporal bone resection and subtotal temporal bone resections were performed in cases with temporal bone cancer. The disease free 5-year survival of the temporal bone cancers was 42% and for the squamous cell carcinomas, it was 44%.     

Giant cell tumors of the jugular foramen.

PURPOSE: To review the diagnosis and treatment of giant cell tumors of the jugular foramen. MATERIALS AND METHODS: A typical case is reported. Symptoms, signs, and diagnostic studies are reviewed. Photomicrographs and angiographic studies showing the differences between these and glomus jugulare tumors are provided. A coherent approach to their management is presented. RESULTS: These hypervascular, traditionally radioresistant tumors may cause pulsatile tinnitus, conductive hearing loss, and lower cranial nerve paresis. Angiographic studies showed a hypervascular lesion supplied by numerous small branches of the external carotid artery, making embolization difficult. Complete resection was achieved by an infratemporal fossa approach with preoperative embolization. CONCLUSION: Giant cell tumors of the temporal bone may mimic glomus jugulare tumors with respect to anatomic location, cranial nerve deficits, and vascularity.     

颞下窝B型径路切除侧颅底肿瘤临床分析

目的探讨颞下窝B型径路在侧颅底肿瘤中的适应证及手术效果。 方法回顾性分析2015年1月—2018年6月采用颞下窝B型径路治疗8例侧颅底肿瘤患者的临床资料,其中横纹肌肉瘤1例,成熟型畸胎瘤1例,骨巨细胞瘤1例,颞骨鳞癌1例,巨细胞修复性肉芽肿2例,胆脂瘤2例。结果3例患者病变范围主要累及颈静脉孔区、颈内动脉、岩尖;5例患者病变范围主要累及颧弓、颞下颌关节、中颅底甚至颞叶。7例单纯行颞下窝B型径路,1例患者行颞下窝B型径路联合经耳蜗径路,8例患者均完全切除病变。所有患者术后1周复查头颅MRI,均未见病变残留。4例患者术后为重度传导性或混合性听力下降,另外4例患者术后为极重度感音神经性听力下降。术前面瘫者2例,术后无加重;术前面神经功能正常者,术后2例出现面瘫,其中1例为联合经耳蜗入路患者术中将面神经进行移位,另外1例由于恶性肿瘤已侵犯面神经,术中将受侵犯的面神经切除。所有患者随访期间均无脑脊液耳漏、颅内出血,颅内感染、偏瘫、死亡等严重术后并发症。 结论颞下窝B型径路在暴露颈内动脉垂直段和水平段、岩尖等部位极具优势,同时这一径路也可用于切除累及颧弓、颞下颌关节甚至累及颞叶的侧颅底肿瘤。     

Lesions involving the jugular foramen: clinical characteristics and surgical management

Conclusion: Lesions involving the jugular foramen (JF) present as various diagnoses. Pulsatile tinnitus is more common in glomus jugulare (GJ) tumors, whereas otalgia and facial nerve paresis are more prevalent in temporal bone malignancies (TBMs). Preoperative facial nerve electroneurography (ENoG) was significantly correlated with postoperative facial nerve function. Objective: To describe the diagnosis and surgical management of lesions involving the JF. Methods: The charts were reviewed for 38 patients who had lesions involving the JF, including 14 patients with TBMs, 11 with GJ tumors, 7 with cholesteatomas, 2 with facial nerve schwannomas, 2 with JF schwannomas, and 2 with cholesterol granulomas. The follow-up data were recorded. Results: The most frequent symptoms included hearing loss (89.47%), followed by otorrhea (47.37%) and pulsatile tinnitus (39.47%). With respect to TBMs, 57.14% of patients complained of otorrhea and otalgia, and 50.00% presented with facial nerve paresis. Among the 13 patients with facial nerve paresis, 53.85% were diagnosed with TBMs. Regarding GJ tumors, 81.82% had pulsatile tinnitus and hearing loss. Among the 25 patients with normal preoperative facial nerve function, the mean facial nerve ENoG reduction was 29.48 ± 29.15%, and the mean postoperative facial nerve score was 77.48 ± 33.13. The correlation coefficient was –0.973 (p = 0.000).     

Management of endolymphatic sac tumors: a case series report

Objective To study clinical characteristics of endolymphatic sac tumor (ELST) and its diagnosis and treatment. Methods ELST was diagnosed in 6 cases based on surgical and histological findings. These cases were reviewed for their clinical manifestations, differential diagnosis and surgical treatment techniques. Results There were 1 male and 5 females in this group, aged from 28 to 59 years (mean age=38.7 years). The tumor was in left ear in 4 cases and in right ear in the other 2 cases. Disease courses ranged from 5 to 30 years (mean duration= 12.6 years). Clinical presentations included sensorineural hearing loss (n=4), otorrhea and tinnitus (n=2), tinnitus and facial spasm(n=1), otorrhea with facial paralysis(n=l), and hearing loss with tinnitus (n=2). None of the cas-es was diagnosed as ELST preoperatively. Two cases were misdiagnosed as glomus jugulare tumor, 2 as chronic suppurative otitis media, 1 as sweat gland adenoma on biopsy and 1 as temporal bone tumor. Tumors were sprgi-tally resected in all 6 cases via the mastoidectomy (n=2) or combined oto-cervical or cranio-oto-cervical ap-proaches(n=4). Postoperative cerebrospinal fluid otorrhea occurred in 1 case. The tumors were confirmed on histo-logical examination to be a low-grade adenocarcinoma. All patients have survived at the time of this paper. Conclusion ELST is rare and commonly misdiagnosed and inadequately treated. Its prognosis is relatively favor-able because of its slow growth rate.     

Surgical management of facial neuromas: lessons learned.

OBJECTIVE: Primary tumors of the facial nerve are rare, representing 1% of all intrapetrous lesions. We analyzed the management and surgical outcomes of 16 patients with multisegment facial neuromas treated at our institution during a 16-year period. STUDY DESIGN: A retrospective chart review. SETTING: Tertiary referral center. PATIENTS: All patients included in the study had surgical management of their facial neuroma. There were 9 women and 7 men. The mean age was 46 years, with a mean follow-up period of 3 years. INTERVENTION: Surgical excision (n = 15) or decompression (n = 1) of facial neuroma. MAIN OUTCOME MEASURES: Tumor location, presenting symptoms, hearing outcomes, and facial function. RESULTS: Thirteen (81%) patients had facial paresis as their presenting symptom. Unilateral hearing loss was present in 9 (56%) patients. Most tumors (n = 15) involved multiple segments of the facial nerve and ranged in size from 1.5 to 7 cm. Fifteen (94%) patients had the tumor completely excised, and 1 (6%) patient underwent needle decompression of the cystic component of the tumor. The geniculate ganglion was the most commonly involved (11 patients, 69%) segment of the nerve, followed by the labyrinthine and tympanic segments. Despite multiple types of reconstructive options used, the best recovery of facial function was a House-Brackmann Grade III in 12 patients. CONCLUSION: Treatment of facial neuromas depends on the extent of tumor, degree of facial paresis, and hearing function. We advocate complete resection of tumor when facial palsy exists. Patients with normal facial function and hearing may be advised on a more conservative treatment option such as radiologic observation, drainage of any cystic component of the tumor for histologic diagnosis, and/or bony decompression of the tumor.     

Transjugular craniotomy for the management of jugular foramen tumors with intracranial extension.

OBJECTIVES: To elucidate indications and outcomes with the transjugular craniotomy for resection of jugular foramen tumors with intracranial extension. The transjugular approach is a lateral craniotomy conducted through a partial petrosectomy traversing the jugular fossa combined with resection of the sigmoid sinus and jugular bulb, which often have been occluded by disease. STUDY DESIGN: Retrospective review. SETTING: University medical center. PATIENTS: Twenty-eight patients with intracranial jugular foramen tumors who underwent a total of 30 surgical procedures. MAIN OUTCOME MEASURES: Pathologic findings, surgical approach, extent of tumor resection, rate of facial nerve mobilization and ear canal closure, facial and lower cranial nerve outcomes, and hearing preservation. RESULTS: Tumors included schwannoma (37%), meningioma (33%), glomus jugulare (23%), and chordoma (7%). The surgical approaches were tailored to maximize functional preservation, and included the transjugular (53%), translabyrinthine (17%), retrosigmoid (10%), and far lateral (7%) craniotomies. Translabyrinthine (3%) or transcondylarfar lateral (3%) approaches were occasionally used in combination with the trans-jugular approach. Most procedures were managed in a single stage (90%), but three patients with massive tumor in the neck required two stages. Microsurgical gross total and near-total tumor removal (37% each) were commonly achieved, although subtotal resections (27%) were occasionally performed. In only a minority of cases was facial nerve mobilization (7%) or ear canal closure (21%) required. If present preoperatively, Grade I facial nerve function was usually maintained (22 of 24 [92%]) and Hearing Class A or B could always be maintained (9 of 9 [100%]). As expected, new lower cranial nerve dysfunction was common (8 of 30 [27%]), although over half of the patients had complete lower nerve palsy preoperatively (16 of 30 [53%]). CONCLUSION: Most patients with jugular foramen tumors with intracranial extension can be managed with a single-stage transjugular craniotomy. Facial nerve mobilization or ear canal closure is usually not required, permitting conservation of facial function and hearing, when present preoperatively.     

Endolymphatic sac tumor: a report of 3 cases and discussion of management

Patients with an endolymphatic sac tumor (ELST) typically present with palsy of cranial nerves VII and/or VIII; other presenting symptoms include hearing loss, otalgia, occipital headaches, cranial nerve palsies, vertigo, gait ataxia, tinnitus, and otorrhea. ELSTs are extremely vascular, and they can invade and destroy temporal bone. Because of these characteristics, they are often mistaken for glomus tumors of the skull base. We describe the clinical presentation, evaluation, and management of ELSTs based on our review of the limited literature and our experience with 3 adults who presented to our tertiary care referral center with large ELSTs. Although these patients presented late in the course of their disease, their symptoms were relatively minor. Preoperative tumor embolization was performed, anda near-complete resection was achieved via an extended transotic approach in all 3 patients. The facial nerve was preserved without transposition in the first patient, the second patient underwent a primary nerve anastomosis, and the third required a cable graft of the facial nerve. Postoperative radiation therapy was administered to 2 of these patients. Follow-up by MRI detected no evidence of recurrence in any of the 3 patients.     

Temporal approach for resection of juvenile nasopharyngeal angiofibromas

OBJECTIVE: To describe a lateral preauricular temporal approach for resection of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN: A retrospective review of five patients with JNA tumors that were resected by a lateral preauricular temporal approach. METHODS: The medical records of five patients who underwent resection of JNA tumors via a lateral preauricular temporal approach were reviewed, and the following data collected: tumor extent, blood loss, hospital stay, and surgical complications. RESULTS: Five patients with JNA tumors had resection by a lateral preauricular temporal approach. These tumors ranged from relatively limited disease to more extensive intracranial, extradural tumors. Using the staging system advocated by Andrews et al., these tumors included stages II, IIIa, and IIIb. Four patients (stages II, IIIa, IIIa, and IIIb) who underwent primary surgical excision had minimal blood losses and were discharged on the first or third postoperative day with minimal transient complications (mild trismus, frontal branch paresis, serous effusion, and cheek hypesthesia). The remaining patient (stage IIIb) did well after surgery, despite having undergone preoperative radiation therapy and sustaining a significant intraoperative blood loss. There have been no permanent complications or tumor recurrences. CONCLUSIONS: A lateral preauricular temporal approach to the nasopharynx and infratemporal fossa provides effective exposure for resection of extradural JNA tumors. The advantages of this approach include a straightforward route to the site of origin, the absence of facial and palatal incisions, and avoidance of a permanent ipsilateral conductive hearing loss.     

A metastatic glomus jugulare tumor. A temporal bone report

The clinicopathologic findings in the temporal bone of a patient with a highly malignant metastasizing glomus jugulare tumor are reported. The patient exhibited all the symptoms of primary malignant tumors of the ear, including facial paralysis, otorrhea, pain, hearing loss, tinnitus, dizziness, and vertigo. He was treated with cobalt irradiation followed by radium implant in the ear canal for a residual tumor; then a left-sided radical mastoidectomy was performed.     

Glomus tumors in patients of advanced age: a conservative approach

OBJECTIVES: Identify and discuss controversies in the management of paragangliomas in elderly patients.Assess and evaluate a conservative treatment strategy involving limited surgical resection and vigilant monitoring of the outcome measures of tumor control, peritreatment morbidity, symptom resolution, and hearing preservation. STUDY DESIGN: Retrospective case review. METHODS: All of the patients in this study were over age 60 with temporal bone glomus tumors. Primary outcome assessment included length of hospitalization, perioperative morbidity, symptom resolution, hearing preservation, and long-term tumor control. RESULTS: Twelve female patients with mean age of 74.5 years (range 61-85 years) with follow-up from 24 months to 33 years (mean/median: 5/7.8 years) were identified. Nine (75%) of the patients presented with pulsatile tinnitus.Seven patients (58%) underwent surgical excision of the middle ear component of the paraganglioma. Tumors extending to the jugular foramen were purposely not resected. Five patients (45%) had relative or absolute contraindications to surgical resection and were treated with observation or primary radiation therapy. Post-treatment audiometric evaluation confirmed stable or improved hearing. Pulsatile tinnitus resolved in all patients. No patient experienced cranial nerve deficits, extended hospitalization, or blood transfusions.All patients were followed closely with radiological imaging. The majority of patients demonstrated no disease or stable disease, while two patients demonstrated tumor growth 6 years after diagnosis. CONCLUSION: A prolonged natural history and the morbidity associated with surgical intervention have led to controversies in the treatment of glomus tumors in an elderly population. Our experience supports recent limited reports advocating conservative surgical excision and vigilant long-term monitoring in this population.     

Results of surgery by the modified extended middle cranial fossa approach in 100 patients with acoustic neuroma

The results of surgery by the middle cranial fossa (MCF) approach or the modified extended MCF approach in 100 patients with acoustic neuroma are reported. The rates of facial nerve preservation, tumor removal, and hearing preservation were reported and discussed. This surgical procedure can be applied to tumors of any size, from tumors confined to the internal auditory canal to those extending into the posterior fossa.     

Meningioma of the jugular foramen: glomus jugulare mimic and surgical challenge

OBJECTIVES: Meningiomas involving the jugular foramen are rare lesions, with approximately 34 cases reported in the English literature. Clinically, these tumors mimic the more common glomus jugulare tumor. After surgical resection, meningiomas have worse cranial nerve outcomes and higher recurrence rates than glomus tumors. There is controversy regarding the selection of surgical approach, particularly with regard to management of the facial nerve. A reliable means of accurate preoperative diagnosis would help surgical planning and patient counseling. STUDY DESIGN: We present a series of six consecutive large jugular foramen meningiomas resected by a single surgeon from 1996 to 2002. METHODS: Retrospective case series (chart review). RESULTS: The preoperative diagnosis was correct in nearly all (6/7) cases on the basis of the characteristic imaging findings seen with a combination of temporal bone dedicated computed tomography and high-resolution enhanced magnetic resonance imaging. Five of six patients had lateral facial nerve rerouting (infratemporal fossa Fisch type A), and three patients also had posterior rerouting (transcochlear approach with division of greater superficial petrosal nerve). Total tumor removal was accomplished in 83%. One patient suffered recurrence over a mean follow-up period of 2.5 years. New postoperative vocal cord palsies occurred in 50% of patients, and all required vocal cord medialization. At 1 year, 50% of patients had normal or near normal (House-Brackmann I or II) facial function. Postoperative cerebrospinal fluid leaks occurred in two patients, and both eventually required ventriculoperitoneal shunts. CONCLUSIONS: Meningiomas involving the jugular foramen are surgically challenging tumors that pose unique diagnostic issues. The majority of these lesions can be completely resected. A relatively high postoperative complication rate, which can be controlled with appropriate intervention, is seen with these surgeries.     

Histopathological temporal bone study of the metastatic rhabdomyosarcoma

We describe the histopathological temporal bone findings of metastatic rhabdomyosarcoma in the patient with hearing loss and facial nerve paralysis. A 45-year-old female was admitted to the hospital with a mass of the left tibia. Surgical operation was performed and the pathological diagnosis was alveolar rhabdomyosarcoma. She showed left facial palsy and bilateral hearing loss. She was pronounced dead because of respiratory arrest caused by multiple metastases including meningeal metastasis after 14 months of total clinical course. Histological examination of the temporal bone revealed that the VII and VIII cranial nerves were involved by tumor cells in the internal auditory canal, and that the organ of Corti was damaged. In addition, the membranous labyrinth showed labyrinthitis. No remarkable bony destruction was observed in the internal auditory canal. Histopathological examination revealed that hearing loss and facial nerve paralysis of the patient was due to temporal bone metastasis of rhabdomyosarcoma.     

Surgical management of previously untreated glomus jugulare tumors

The treatment of glomus jugulare tumors is controversial. Changes in the surgical treatment of glomus jugulare tumors at The House Ear Clinic have allowed complete resection in 85% of patients with minimal morbidity and no surgical mortalities. Our experience with 52 previously untreated patients with glomus jugulare tumors is reviewed. Two primary surgical techniques were used. The mastoid/neck approach was used in 9 patients with small tumors limited to the jugular bulb. The infratemporal fossa approach was used in the remaining 43 tumors. Lower cranial nerve preservation was possible in the majority of patients with normal preoperative function. Modifications in the management of the facial nerve during the infratemporal fossa approach have resulted in good recovery of facial function (House grade I/VI or II/VI) in 95% of patients. Most patients (85%) were able to fully resume all preoperative activities. Our results suggest that surgical management is the treatment of choice in younger patients with glomus jugulare tumors.     

Circumferential petrosectomy for petrous apicitis and cranial base osteomyelitis.

OBJECTIVE: Petrous apicitis and cranial base osteomyelitis are life-threatening conditions. A surgical management may be necessary in cases that progress, in conditions that fail to improve with medical treatment, or in cases with impending complications. In this study, we describe a technique to remove the maximum amount of infected temporal bone while preserving the integrity of the peripheral auditory pathway and facial nerve. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral hospital. PATIENTS: Five patients with impending complications, whose disease progressed or whose conditions failed to improve while on culture-directed antibiotics underwent circumferential petrosectomy. INTERVENTIONS: The circumferential petrosectomy removes most of the temporal bone around the external, middle, and inner ear. A combined retrolabyrinthine-apical petrosectomy is performed in conjunction with the fallopian bridge technique using a transmastoid and middle cranial fossa approach. A split temporalis muscle flap is used to bring vascularized tissue to the mastoid, jugular foramen, and petrous apex. MAIN OUTCOME MEASURES: Disease resolution, change in hearing or facial nerve function, complications. RESULTS: Each of the five patients had modifications to the procedure tailored to their disease extent: three had disease primarily involving the petrous apex and two had disease adjacent to the jugular foramen. Additional cultures of the infected bone were obtained during surgery. A culture-directed antibiotic therapy (duration, 6-10 weeks) was administered after surgery, which resulted in the complete resolution of the disease and the associated symptoms in all five patients. No patient experienced hearing loss or facial nerve dysfunction as a result of the surgery within at least 1 year of follow-up in four of the five patients in this series. CONCLUSION: The circumferential petrosectomy is a potential treatment option when medical treatment fails in patients with petrositis or cranial base osteomyelitis. It permits maximal temporal bone debridement while preserving hearing and facial nerve integrity in these life-threatening disease processes.     

Posterior petrous face meningiomas: an algorithm for surgical management.

OBJECTIVE: The objective of the present study was to report our surgical strategy in the management of 81 patients with posterior petrous face meningiomas. STUDY DESIGN: Retrospective study. SETTING: This study was conducted at a quaternary private otology and cranial base center. PATIENTS: Of 139 patients with posterior fossa meningioma, 81 occurred on the posterior petrous face of the temporal bone and were the object of this study. INTERVENTIONS: Thirty-one patients were approached by the enlarged translabyrinthine approach. The enlarged translabyrinthine approach with transapical extension Type II was performedin 29 patients. The combined retrosigmoid-retrolabyrinthine approach was chosen in 8 cases. The modified transcochlear approach Type A with permanent posterior transposition of the facial nerve (FN) was performed in 6 patients. Two patients underwent a retrolabyrinthine subtemporal transapical approach. One patient underwent a transpetrous middle cranial fossa approach. Four patients with intracanalicular meningiomas were operated on through the enlarged middle cranial fossa approach. RESULTS: Total removal of the tumor (Simpson Grades I and II) was achieved in most patients (92.5%). The FN was anatomically preserved in 79 of the 81 (97.5%) patients. Five patients had less than 1 year follow-up, and 2 patients were lost to follow-up and were excluded in evaluation of the final FN outcome. At 1-year follow-up, 46 patients (63%) had Grade I to II, 19 (26%) had Grade III, 4 (5.4%) had Grade IV, 1 (1.3%) had Grade V, and 3 (4.1%) had Grade VI. Hearing-preserving surgery was attempted in 15 patients (18.5%) with preoperative serviceable hearing. Of these 15 patients, 11 had their hearing preserved at the same preoperative level, and 4 experienced postoperative deafness. Postoperatively, a new deficit of 1 or more of the lower cranial nerves was recorded in 3 patients. One patient experienced subcutaneous cerebrospinal fluid collection that required surgical management. CONCLUSION: Total tumor removal (Simpson Grades I-II) remains our treatment of choice and takes priority over hearing preservation. Subtotal resection is indicated for older and debilitated patients with giant lesions to relieve the tumor compression on the cerebellum and brainstem. Subtotal removal is also preferred in the face of the absence of a plane of cleavage between the tumor and the brainstem, in the presence of encasement of vital neurovascular structures, in elderly patients with tumors adherent to preoperatively normal facial or lower cranial nerves.     

Facial function in hearing preservation acoustic neuroma surgery

OBJECTIVE: To determine if facial function is worse after hearing preservation acoustic neuroma surgery (retrosigmoid and middle fossa) than in translabyrinthine surgery. DESIGN: Retrospective medical record review. SETTING: Private neuro-otology subspecialty practice of patients operated on in a tertiary care hospital. PATIENTS: This study evaluated 315 consecutive acoustic neuroma surgical procedures between April 1989 and July 1998. A total of 209 translabyrinthine procedures and 106 hearing preservation surgical procedures were performed. The hearing preservation procedures were equally divided between retrosigmoid (n = 48) and middle fossa (n = 58) procedures. METHODS: Medical records were reviewed and tabulated for tumor size, surgical approach, and House-Brackmann facial function grade at short-, intermediate-, and long-term intervals. RESULTS: Postoperative facial function in hearing preservation surgical procedures at short- and long-term follow-up was not worse than facial function after translabyrinthine surgical procedures in comparably sized tumors. CONCLUSION: Concern about postoperative facial function should not be the deciding factor in selecting hearing preservation vs nonhearing preservation acoustic neuroma surgery.     

Stereotastic radiosurgery for glomus jugulare tumors

OBJECTIVES/HYPOTHESIS: Surgery is considered to be the mainstay of treatment for glomus jugulare tumors. A subset of patients are poor surgical candidates based on age, medical problems, tumor size, or prior treatment failure. The purpose of this study was to review our results with stereotactic radiosurgery (gamma knife treatment) in this group of patients, with particular attention to adverse reactions and symptom relief. STUDY DESIGN: Retrospective review and phone survey. METHODS: Charts were reviewed for size and location of tumor, history of previous treatment, symptoms before and after treatment, amount of radiation received, acute and late complications, and functional level before and after treatment. Pre-treatment and posttreatment magnetic resonance imaging scans were also reviewed. Identified patients were then contacted for a phone interview. RESULTS: Eight patients were identified. Phone interviews were conducted with four patients. Four patients had failed previous treatment. Follow-up ranged from 7 to 104 months. One patient experienced an acute complication: intractable vertigo requiring hospitalization. No patient experienced delayed cranial neuropathies. No patient reported worsening of any of the following symptoms: pulsatile tinnitus, hearing loss, facial weakness, hoarseness, or difficulty swallowing. Three patients reported improvement in their pulsatile tinnitus. Two patients reported improvement in hearing loss, and one patient each reported improvement in vertigo and difficulty swallowing. CONCLUSIONS: Preliminary results suggest that stereotactic radiosurgery is useful to control symptoms and may be delivered safely in patients with primary or recurrent glomus jugulare tumors who are poor surgical candidates.     

Unusual presentation of a giant glomus tumor

Giant glomus tumors pose a challenge to the Otologist by virtue of their location and vascularity. A vast majority of them present with tinnitus, conductive hearing loss and cranial nerve palsies. We report the case of a 16-year-old male patient who presented with sudden right-sided sensorineural hearing loss. This is an unusual presentation of a giant glomus tumor. We present the clinical features and management of this unusual case.