Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Endovascular De-Vascularization of the Jugulo-Tympanic 'Aggressive-Paraganglioma'


Affiliations
1 Dept of Neurosurgery, B.J. Govt Medical College, Pune, India
2 Ruby Hall Clinic, India
3 Ruby Hall Clinic, Pune, India
4 Poona Hospital, Pune, India
     

   Subscribe/Renew Journal


Background: Jugulotympanic 'aggressive-paraganglioma' (JTa-P) grows rapidly, within months intrudes in to jugular bulb, labyrinth and compresses the lower cranial nerves (LCN). Scanty cellularity and intense-vascularity complicates tumor surgery. Post-surgically, it yields large volumes of residues and results in LCN-palsy. With increased recurrence rate it causes more morbidity and mortality.

Objective: 1. Radio-imaging early the aggressive-phenotypes. 2. De-vascularization and super-selective endovascular arterial embolization(EAE) of the tumor feeding arteries for better surgical outcome.

Material & Method: Computerized tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) characteristically defines the aggressive phenotypes. Seven patients of intractable vertigo and lower cranial nerve palsy diagnosed and devascularized between 2008 and 2012 years. JTa-P categorized as Type 1, Type 2, Type 3 and Type 4. Pre-surgically adequate de-vascularization of vascular blush-map (90%) along with EAE performed, followed by surgery between 3rd and 5th day of the de-vascularization. It gives maximum avascularity.

Results: Subtotal radical excision was possible. LCN-functions could be preserved in 42.85%. Morbidity reduced to 50%. Vertigo tinnitus improved. Four year follow up showed no tumor recurrence.

Conclusion: 1. Radio imaging gives early diagnosis. 2. Endovascular de-vascularizationis an useful adjunct in reducing morbidity and mortality.


Keywords

1) Jugular Foramen Syndrome, 2) Aggressive-Jugulo-Tympanic Paraganglioma, 3. Radio-Imaging, Digital Subtraction Angiography (DSA), 4. De-Vascularization and EAE.
Subscription Login to verify subscription
User
Notifications
Font Size


  • Fliedner SM, Lehnert H, Pacak K; Metastatic paraganglioma. SeminOncol. 2010 Dec; 37(6):627-37. doi: 10.1053/j.seminoncol.2010.10.017
  • WL Olsen, WP Dillon, WM Kelly, D Norman, M Brant-Zawadzki and TH Newton American Journal of Roentgenology. 1987;148: 201-204. 10.2214/ ajr.148.1.201
  • Schwaber M K, Glasscock M E, Nissen A J, Jackson C G, Smith P G. Diagnosis and management of catecholamine secreting glomus tumors. Laryngoscope. 1984;94:1008–1015.
  • Havekes B, van der Klaauw AA, Hoftijzer HC, Jansen JC, and van der Mey AG, Vriends AH. Reduced quality of life in patients with head and neck paragangliomas. Eur J Endocrinol. 2008 Feb. 158(2):247-53.
  • Rao AB, Koeller KK, Adair CF. From the archives of the AFIP. Paragangliomas of the head and neck: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics. 19 (6): 1605-32.
  • Jansen JC, van den Berg R, Kuiper A, et al. Estimation of growth rate in patients with head and neck paraganglioma influences the treatment proposal. Cancer 2000; 88:2811–2816
  • McNeil AR, Blok BH, Koelmeyer TD et al: Phaeochromocytomas discovered during coronial autopsies in Sydney, Melbourne and Auckland. Aust NZJ Med 2000; 30 (6): 648)
  • CJM LipsEmail author, EGWM Lentjes, JWM Höppener, RB van der Luijt and FL Moll; Familial paragangliomas; Hereditary Cancer in Clinical Practice20064:169
  • Spector GJ, Druck NS, Gapo M. Neurologic manifestations of glomus tumors in the head and neck. Arch Neurol 1976; 33:270-274
  • Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 2002;97:1356–1366.
  • Eisenhofer G, Bornstein SR, Brouwers FM, et al. Malignant pheochromocytoma: current status and initiatives for future progress. Endocrine-related cancer. 2004 Sep; 11(3):423–436. [PubMed]
  • Young AL, Baysal BE, Deb A, Young WF., Jr. Familial malignant catecholamine-secreting paraganglioma with prolonged survival associated with mutation in the succinate dehydrogenase B gene.The Journal of clinical endocrinology and metabolism. 2002 Sep; 87(9):4101–4105.
  • Hawthorne MR, Makek MS, Harris JP, FischU.The histopathological and clinical features of irradiated and non-irradiated temporal paragangliomas. Laryngoscope 1988; 98(3):325–331.
  • Kukherji SK, Kasper ME, Rart RP, Mancuso

Abstract Views: 248

PDF Views: 0




  • Endovascular De-Vascularization of the Jugulo-Tympanic 'Aggressive-Paraganglioma'

Abstract Views: 248  |  PDF Views: 0

Authors

R. Sangle
Dept of Neurosurgery, B.J. Govt Medical College, Pune, India
V. Nivargi
Ruby Hall Clinic, India
P. Dixit
Ruby Hall Clinic, Pune, India
V. Kulkarni
Poona Hospital, Pune, India

Abstract


Background: Jugulotympanic 'aggressive-paraganglioma' (JTa-P) grows rapidly, within months intrudes in to jugular bulb, labyrinth and compresses the lower cranial nerves (LCN). Scanty cellularity and intense-vascularity complicates tumor surgery. Post-surgically, it yields large volumes of residues and results in LCN-palsy. With increased recurrence rate it causes more morbidity and mortality.

Objective: 1. Radio-imaging early the aggressive-phenotypes. 2. De-vascularization and super-selective endovascular arterial embolization(EAE) of the tumor feeding arteries for better surgical outcome.

Material & Method: Computerized tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) characteristically defines the aggressive phenotypes. Seven patients of intractable vertigo and lower cranial nerve palsy diagnosed and devascularized between 2008 and 2012 years. JTa-P categorized as Type 1, Type 2, Type 3 and Type 4. Pre-surgically adequate de-vascularization of vascular blush-map (90%) along with EAE performed, followed by surgery between 3rd and 5th day of the de-vascularization. It gives maximum avascularity.

Results: Subtotal radical excision was possible. LCN-functions could be preserved in 42.85%. Morbidity reduced to 50%. Vertigo tinnitus improved. Four year follow up showed no tumor recurrence.

Conclusion: 1. Radio imaging gives early diagnosis. 2. Endovascular de-vascularizationis an useful adjunct in reducing morbidity and mortality.


Keywords


1) Jugular Foramen Syndrome, 2) Aggressive-Jugulo-Tympanic Paraganglioma, 3. Radio-Imaging, Digital Subtraction Angiography (DSA), 4. De-Vascularization and EAE.

References