A 42-year-old woman presented with otorrhea 22 years after extracranial resection of a
norepinephrine-secreting
glomus jugulare tumor with intravascular embolization and
radiation therapy to the intracranial portion of the
tumor.
Tumor growth was arrested and was associated with a decrease in blood and urine
norepinephrine levels. Extensive evaluation of the otorrhea, including computerized tomography-cisternography,
gadolinium-enhanced magnetic resonance imaging, and arteriography showed marked diffuse
necrosis of the temporal bone and skull base with limited
tumor vascularity. Cerebrospinal fluid (CSF) collected from the right ear showed
norepinephrine levels of 2975 pg/ml; plasma
norepinephrine levels were normal. The precise site of CSF leakage could not be delineated. Exploration of the posterior fossa revealed a large dural defect at the anteromedial aspect of the petrous bone through which CSF flowed over the surface of the residual extradural
glomus tumor. The defect was successfully sealed with a fascial patch. Postoperatively, CSF
norepinephrine levels were normal and no further leakage was observed.