HSC Section 8_April 2017

Jugular Paragangliomas

Fig. 7. Pre- and postembolization angiography of a GJT. ( A ) Pre-embolization image in which an arrow designates the highly vascularized tumor. ( B ) Postembolization image in which the major vascular pedicles for the tumor have been obliterated.

or younger patients with large tumors and intact CN who are troubled by aural symp- toms such as pulsatile tinnitus, conductive hearing loss, and fullness. In a previous report, Cosetti and colleagues 9 reviewed the role of conservative management of JP and glomus tympanicum in patients over the age of 60 years. In a small sample, they found that 1 of 3 patients experienced tumor growth following subtotal resection nearly 6 years after treatment. In a study of patients over the age of 60 with advanced tumors, Willen and colleagues 24 identified no significant treatment failures at 19 months of mean follow-up with planned subtotal resection and adjuvant radio- therapy. Unfortunately, the published follow-up for these reports is generally short and limited by a relatively small number of cases. However, at this time, the authors’ treatment algorithm has evolved to include subtotal resection. Akin to other benign skull base tumors, the authors believe that tumor recurrence is likely related to extent of resection. That is, the more tumor that is removed, the less likely the residual tumor is to grow. Radiation Because of the complexity of JP surgery, particularly regarding the close proximity of a vascular tumor to the facial nerve, the lower CN, and the carotid artery, nonsurgical management options such have radiation have emerged. Initially, fractionated external beam radiation was introduced for primary and salvage therapy. Control rates between 86% and 100% were described in early studies, which helped to establish the legitimacy of radiotherapy in the management algorithm for JP. 25–27 Over time, the use of therapeutic radiation evolved to employ stereotactic techniques that offer comparable tumor doses with less radiation injury to surrounding tissue. Radiosurgery is now a well-accepted treatment modality for GJT. The treatment- specific tumor control and adverse effect profile has been shown to be least

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