Successful Onyx embolization of a giant glomus jugulare: case report and review of nonsurgical treatment options.

Abstract

BACKGROUND:

Otorrhagia is an uncommon but severe symptom of patients with large glomus jugulare tumors that erode through the tympanic membrane. In this case report we describe the use of transarterial embolization for long-term palliative management of otorrhagia in a patient with an unresectable glomus jugulare tumor.

CASE DESCRIPTION:

A 53-year-old woman presented with intermittent otorrhagia 10 years after subtotal resection of a glomus jugulare tumor. Follow-up magnetic resonance imaging showed progressive enlargement of the tumor with significant extension into the posterior fossa. Resection was thought to be impractical; therefore, transarterial embolization was offered as a palliative measure to help reduce the frequency and severity of bleeding episodes.

RESULTS:

Long-term control of otorrhagia was achieved after three rounds of intra-arterial embolization. In round one, the tumor was embolized from multiple external carotid artery feeding branches by the use of polyvinyl alcohol particles. In round two, the internal carotid artery was sacrificed by embolizing the cavernous and petrous segments with coils. In round three, persistent feeders from the cervical internal carotid artery were embolized with Onyx. In 6 years of clinical follow-up, the patient has had no otorrhagia or new neurological deficits. Serial magnetic resonance imaging revealed there has been no significant interval tumor growth.

CONCLUSION:

Long-term control of otorrhagia from glomus jugulare tumors can be safely achieved by intravascular embolization with Onyx.

• Authors: John C Dalfino, Doniel Drazin, Anil Nair, Edward Gifford, Alan S Boulos
• Journal: World neurosurgery (World Neurosurg) 2014 May-Jun Vol. 81 Issue 5-6 Pg. 842.e11-6 ISSN: 1878-8769 [Electronic] United States
• PMID: 23313234 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Onyx copolymer
• Polyvinyls
• Dimethyl Sulfoxide

Topics

• Cerebrospinal Fluid Otorrhea (pathology, therapy)
• Dimethyl Sulfoxide
• Embolization, Therapeutic (methods)
• Female
• Glomus Jugulare (pathology)
• Glomus Jugulare Tumor (pathology, surgery, therapy)
• Humans
• Middle Aged
• Palliative Care (methods)
• Polyvinyls
• Retreatment
• Treatment Outcome