Introduction: Glomus jugulare and glomus tympanicum tumors are rare, benign, and highly vascular paragangliomas which can present with symptoms of mass effect, cranial nerve palsies, and adrenergic activation due to catecholamine secretion activity. The safety and efficacy of endovascular embolization of these lesions prior to surgical resection, has not been previously examined.
Methods: A retrospective review of all patients who underwent endovascular embolization for the treatment of glomus jugulare and glomus tympanicum tumors, between 2008 and 2016, was performed. Patients who underwent subsequent surgical resection were included in the analysis. Patient demographics, clinical presentation, embolization and surgical resection parameters, and functional outcomes at follow-up, were assessed.
Results: Fifteen (75.0%) and 5 (25.0%) patients underwent embolization and surgical resection for the management of glomus jugulare tumors and glomus tympanicum tumors, respectively. The median age of these patients was 54.6 with a female-to-male ratio of 0.43. Hearing loss and (18; 90.0%) pulsatile tinnitus (7; 35.0%) were the 2 most frequent symptoms at time of presentation. A balloon test occlusion was performed in 6 (30.0%) patients, which was tolerated in each case. Microparticles, coils, or glue were used for embolization in 18 (90.0%), 14 (70.0%), and 12 (60.0%) cases, respectively. Type of material used was not associated with outcome (Fisher’s exact, P=0.185). The occipital (12; 60.0%) and ascending pharyngeal (12; 60.0%) arteries were most commonly embolized. Median pre-operative mRS was 2 (range 1-3). No patients had a change in mRS immediately after surgery. Patients were followed for a mean of 38 months. Median last-follow-up mRS was 1 (range 1-3). Most patients had long-term improvement (12; 60%), and only one had a drop in mRS from 1 to 2, due to tumor recurrence and reoperation. No patients undergoing embolization had any significant intraoperative or postoperative blood loss. Most patients had no postoperative complications (45%), and the most common complications were hoarseness (25%) and CSF leak (20%).
Conclusions: Embolization before resection of glomus tumors is a safe and effective procedure with no immediate postoperative change in patient mRS, and no intraoperative or postoperative bleeding complications. Type of embolization material did not affect outcomes.
Patient Care: Our research will identify the utility of embolization of these highly vascular tumors, before they are excised, to reduce blood loss and reduce surgical complications.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe a possible adjunct before excision surgery in glomus tumors, 2) Discuss in small groups the utility of such a procedure, 3) Identify cases where embolization would be useful before excision.