Hypoglossal Nerve Palsy As an Initial Presentation of Glomus Jugulare Tumor in Patient with Breast Cancer: A Case Report and Literature Review

Background: Glomus jugulare tumor is a rare, slow-growing, hyper-vascular paraganglioma that originates from the neural crest derivatives in the wall of the jugular bulb. The most common clinical manifestations of glomus jugulare are pulsatile tinnitus, conductive hearing loss, and hoarseness due to its vascularity and invasion of surrounding structures. Isolated hypoglossal nerve palsy as a presenting feature of the glomus jugulare is very rare. Case Report: We report a 61-year-old woman with a past medical history of breast cancer and diabetic mellitus presenting with progressive difficulty handling food in her mouth and tongue atrophy. Investigations showed skull base lesion and solitary pulmonary nodule. Further work-up led to glomus jugulare and benign solitary pulmonary fibrous tumor diagnosis, although the first impression was metastatic involvement of the jugular foramen. Endovascular embolization of the glomus jugulare was performed, but the patient refused any open surgery due to co-morbidities and the risk of operation. She had no new symptoms at the one-year follow-up, and the size of the lesion became more minor on the follow-up imaging relative to the baseline. Conclusion: Glomus jugulare tumors should be considered and surveyed in the diagnostic work-up of patients with hypoglossal nerve palsy. [GMJ.2021;10:e2222]

Extradural Transjugular Transsigmoid Approach with High Cervical Exposure for Glomus Jugulare Tumor

Surgical removal of glomus jugulare tumors is challenging owing to the complex anatomy of the temporal bone and craniocervical region, aggressive tumor invasion into the nearby structures, and their hypervascularity. However, recent advances in skull base techniques, intraoperative neuromonitoring, and radiological interventions have enabled their relatively safe resection, while giving priority to functional preservation. This video demonstrates a case of a glomus jugulare tumor treated by the extradural transjugular transsigmoid approach with high-cervical exposure and tympamoplasty, after preoperative embolization. A 47-year-old woman presented with progressive hearing disturbance, pulsatile tinnitus, and hemifacial spasm. Neuroimaging displayed a hypervascular tumor occupying the temporal bone, extending to the cervical region through the jugular foramen, and to the external auditory canal. Preoperative feeder occlusion was successfully performed without any additional symptoms, while carefully evaluating the provocative test. Near-total resection of the tumor was achieved through the transjugular transsigmoid approach with high-cervical exposure under detailed neuromonitoring, including continuous facial nerve monitoring and auditory brainstem response. In this patient, in whom the tumor did not invade intradurally and the sigmoid sinus was already occluded preoperatively, the sinus was managed only by coagulation, to avoid unnecessary dural opening and the risk of cerebrospinal fluid leakage. Anterior facial nerve rerouting was not required since the tumor removal was accomplished through the corridor above and below the fallopian bridge. The patient had no new neurological deficits, and her pulsatile tinnitus and hemifacial spasm disappeared after the surgery. Her hearing disturbance improved postoperatively.The link to the video can be found at: https://youtu.be/gqf3dxHlv_0.

Management of a complex glomus jugulare tumor with severe brainstem compression

Surgery of glomus jugulare tumors is complex, but when these tumors have a large intradural component and cause brainstem compression they became a challenge to the surgeon. It is crucial to preoperatively understand the anatomy of the tumor and analyze its relationship with the temporal bone, facial nerve, and foramen jugular neurovascular structures. We present a case of a male patient with a complex glomus jugulare tumor causing severe brainstem compression. Nuances of technique and surgical pearls related to the management of complex jugulare tumors are discussed and illustrated in this operative video.The video can be found here: https://youtu.be/oCjzp0kFRGc.

Glomus Jugulare Tumor Presenting as Deep Vein Thrombosis

Intraluminal filling defect and non-compressibility of the vein are diagnostic of a deep vein thrombosis (DVT). However, other etiologies can present with features similar to DVTs; these include tumors extending into the vein and primary tumors arising from the vein such as leiomyosarcoma and hemangioendothelioma. Here, we present a case of an 80-year-old female with a right glomus jugulare tumor (GJT) with extension into the right internal jugular vein mimicking a DVT. This case report presents the sonographic features of GJT presenting as DVT and review of the literature of other tumors that can present in a similar fashion.