| Objects: Through case analysis and review of the literature, we investigate the heredity, biological behavior, clinical features, diagnosis, management and prognosis of glomus jugulare tumor(GJT) that is rare in the head and neck tumors to improve the awareness of this disease.Methods: The clinical information for four cases of GJT in Fujian Provincial Hospital from January 2011 to June 2015 was retrospectively reviewed. A comprehensive revi--ew of both the English and Chinese language medical literature retrieval system and databases was performed using established methodology to identify similar cases for clinical analysis. And the clinical characteristics and treatment strategy were summar--ized.Results: With the case we reported in this paper,there were 3 females and 1 male,aged from 27 to 54 years old. Pulsatile tinnitus in 3 cases, varying degrees of hearing loss in all cases, red mass could be found in the external acounstic meatus or the posterior of tympanic membrane in all cases, pituitary tumor combined in 1 case, gastric stromal tumor was found combind after a close follow-up of 30 months. The ascending pharyngeal artery is the blood supply of the tumor in 1 case.The occipital artery and the posterior auricular artery were the blood supply of the tumor in 1case. The ascending pharyngeal artery and the posterior auricular artery were the blood supply of the tumor in 1case. The multiple branches of the external carotid artery are the blood supply of the tumor in 1 case. The internal carotid artery did not participate in blood supply in all cases.All the patients were got surgery after embolization from 24 to 48 hours. The lesions involved the mastoid, tympanic and jugular foramen in 3 cases. The lesions involved the mastoid, tympanic and part of the petrous bone in1case. Posterior lateral approach in all cases. Ear-neck combined approach in 3 cases. Posterior mastoid approach in 1 case.Gross-total resection the tumor and subtotal resection of temporal bone in all case. Facial nerve paralysis occurred after surgery in 2 cases,hearing loss in 1 case. The resected tissue was in line with the characteristics of paraganglioma in all cases.The Immuno histochemistry such as NSE?Cg A?SY and S-100 was was positive expression in all cases. CK?EMA were negative in which had test. After a close follow-up of 48-58 months, one had survived at the time of this work and also shown no local recurrence, two patients survived but reccurenced, and one patient reccurenced without further treatment and dead after a close follow-up of 50 month(Maybe the brain stem and cerebellum were involved).Conclusion: GJT belongs to head and neck paraganglioma,and it is rare but benign.Few tumors are functional with catecholamine secretion. Its occurrence is related to the mutation of SDH gene, and those who get the mutation of SDH gene may merge with other tumors. We could diagnose GJT with typical clinical manifestations and imaging. DSA is of great value in the evaluation of tumor blood supply. It needs indentify with otitis mediacarcinoma of middle ear, schwanno--ma,meningioma and so on.The operation is the main treatment method, and extract early can reduce the rate of complications and recurrence. Some tumors are difficult to be gross-total resected, and subtotal resection can reduce the complications. Preoperative arterial embolization is an adjuvant therapy to reduce intraoperative bleeding and inhibit tumor growth. In order to reduce the serious complications after embolization or ligation of the internal carotid artery,we had batter execute balloon test occlusion before. The functional GJT perioperative management is different. Before the surgery,oral?-blocker administration is initiated and coil embolization of the tumor vessel is performed 1 week before surgery.Stereotactic radiotherapy has become a new therapy for GJT, and it is playing an increasingly important role. |
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