Skull base surgery for removal of temporal bone tumors

CONCLUSION

When selecting the appropriate surgical approach the pathological type of tumor, the physiological status as well as the functional aspects should be considered. Understanding the strengths and weaknesses of each surgical technique and knowledge of the particular tumor biology facilitates selection of the most appropriate surgical approach and a successful outcome.

OBJECTIVES

The purpose of this study was to review cases that underwent skull base surgery for a variety of tumors that involved the temporal bone. We reviewed a single center's 25-year experience for epidemiologic characteristics, symptoms, treatment type and outcomes.

PATIENTS AND METHODS

The medical records and radiological images of 91 patients, who underwent skull base surgery, were retrospectively reviewed.

RESULTS

Among the 91 patients, 61 cases had benign disease and 30 had malignancies. A facial nerve schwannoma was the most common benign intratemporal tumor and a squamous cell carcinoma was the most common malignant tumor. With the facial nerve schwannoma, facial nerve paralysis and hearing loss were the most common presenting complaints; otalgia was the most common presenting symptom for temporal bone cancer. For patients with a glomus tumor, there was a characteristic pulsating tinnitus. A majority of the facial nerve schwannomas were resectable through the transmastoid approach. The infratemporal fossa approach type A was usually required for lower cranial nerve schwannomas and glomus jugulare tumors. However, the fallopian bridge technique with hypotympanectomy was another surgical option. Partial temporal bone resection and subtotal temporal bone resections were performed in cases with temporal bone cancer. The disease free 5-year survival of the temporal bone cancers was 42% and for the squamous cell carcinomas, it was 44%.

Gastric glomus tumor: a hypervascular submucosal tumor on power Doppler endosonography

Gastric glomus tumors are rare submucosal lesions that typically occur in the fourth endosonographic layer. We describe a 69-year-old patient who presented with intermittent epigastric pain and in whom a submucosal tumor was encountered during upper gastrointestinal endoscopy. Endosonography revealed a heterogeneous, hypoechoic fourth-layer tumor. Power Doppler imaging revealed prominent intratumoral vascular signals demonstrating its hypervascular nature. A diagnosis of glomus tumor was made via histopathologic evaluation of the resected tumor.

Schmerzhafter Tumor am Kniegelenk: Kasuistik und Literaturübersicht

PURPOSE/BACKGROUND

Glomangiomas are perivascular tumours which, on the whole, are rare. They are most frequently located subungually on the fingers and toes. Diagnosis is difficult when they are atypically located at the knee joint. This may frequently result in a course of disease extending over many years.

MATERIAL AND METHODS

The case of a 75-year-old male patient with a tumour which had existed for two years, located at the knee joint, is reported.

RESULTS

Symptomatology, diagnostics, histology and therapy are presented and discussed in the context of the currently available literature relevant to this disease. In the case presented here, following removal of the tumour, the patient remained free of complaints and did not suffer a relapse.

CONCLUSION

Glomangiomas exhibit local, invasive growth, metastases have not been reported. The clinical picture is characterised by the classical trilogy of sensitivity to pain, pressure and temperature. In cases associated with the knee joint, misdiagnoses such as meniscus lesions or degenerative changes, are frequently made. Diagnostic procedures include sonography and magnetic resonance investigations. A resection of the tumour should be carried out well into the healthy tissue, as local relapse is a frequent occurrence in this disease.

Glomus tumors: therapeutic role of selective embolization

The primary goals of preoperative embolization of glomus tumors are to reduce the blood loss in the surgical field, minimize the risk of operative complications, and prevent recurrence by contributing to complete resection. Obliteration of a vascular channel may provide additional help in symptomatic relief by decreasing the tumor volume. Selective transarterial embolotherapy outcomes of 17 patients, most of whom had inoperable tumors and were unable to have surgery/radiotherapy because of poor general health, were evaluated to investigate the therapeutic contributions, efficacy, and safety of embolization techniques in the treatment of different glomus tumors and to examine the role of the embolotherapy in the treatment algorithm of such lesions. The pattern of vascular supply of these tumors was also documented. Eleven glomus jugulotympanicum, 4 glomus caroticum, and 2 glomus vagale tumors were embolized for palliative or curative purposes between 1992 and 2000. Coils and combination of coils plus polyvinyl alcohol were used for embolization. Relief of symptoms and patient satisfaction were analyzed within 3 months after the intervention by a questionnaire combined with full ear, nose, and throat and neurological examinations. The results indicate that the use of embolotherapy in the treatment of glomus tumors must be basically preoperative but is not curative.

[Diagnostic image (114). A woman with pulse-synchronous tinnitus. Glomus tumor in the ear]

A 58-year-old woman with pulse-synchrone tinnitus was diagnosed with a glomus tumour in the right middle ear.

An unusual case of multiple recurrence of a glomangioma

Glomus tumour is a benign lesion arising from the glomus apparatus of the skin and subcutaneous tissue. Glomangioma is the angiomatous variant, which is uncommon. We report a very rare presentation of a glomangioma with multiple recurrences. We advocate preoperative angiography to delineate the extent of the lesion to facilitate complete excision.

Subungual glomus tumor: combined use of MRI and three-dimensional contrast MR angiography

We describe a case of digital glomus tumor diagnosed by MRI and three-dimensional contrast MR angiography (MRA). Images provided the formal definitive diagnosis and the precise localization of the tumor, guiding the necessary surgical resection. It is possible that noninvasive MRA could replace conventional arteriography for the evaluation of patients with clinical suspicion of glomus tumor.

Preoperative embolization of paragangliomas and angiofibromas. Measurement of intratumoral arteriovenous shunts

OBJECTIVE

To determine if technetium Tc 99m-labeled macroaggregated albumin selective angioscintigraphy enables estimation of microparticle-arteriovenous shunt in branchial paragangliomas and nasopharyngeal angiofibromas.

DESIGN

Technetium Tc 99m-labeled macroaggregated albumin particles with calibrated diameters between 25 and 50 microns were administered during selective catheterization of the feeding arteries in 4 branchial paragangliomas (glomus tumors) and 4 nasopharyngeal angiofibromas. Preliminary measures of the activity of the tumor region and of the lungs were obtained in the angiography suite using a hand-held detector. Without changing the position of the microcatheter, definitive embolization was performed. After endovascular treatment, scintigraphy was performed and the pulmonary shunt index was calculated with the use of a gamma camera and a dedicated computer program.

RESULTS

The pulmonary shunt index varied between 0% and 36% for branchial paragangliomas (glomus tumors) and between 82% and 95% for angiofibromas.

CONCLUSIONS

Our results provide new evidence that the incidence of microparticle-arteriovenous shunt in nasopharyngeal angiofibromas is much higher than in paragangliomas.

The value of magnetic resonance imaging in the differential diagnosis of parapharyngeal space tumours

Between 1987 and 1993 14 patients with a parapharyngeal space tumour were imaged by magnetic resonance imaging (MRI). The vagal body tumours, presenting in the poststyloid compartment, all showed flow voids with anterior and medial displacement of the internal carotid artery. None of the salivary gland tumours, all presenting in the prestyloid compartment with posterior displacement of the internal carotid artery, showed flow voids. MRI is superior compared with other modalities in evaluating the differential diagnosis, especially regarding vascular vs non-vascular tumours. It should encompass T1 SE images to assess the presence or absence of flow voids. In vascular tumours angiography must be used to assess feeding vessels, multiplicity, and sides involved. T1 GE images are useful as they allow superior identification of the internal carotid artery and its relation with the tumour accordingly. In addition to T1 SE images, T2 SE images may help in the evaluation of the differential diagnosis. In all non-vascular tumours aspiration cytology is required to differentiate between benign and malignant disease.

Perivascular spaces in eccrine spiradenoma. A clue to its histological diagnosis

Perivascular spaces were found to represent a useful histological clue to the diagnosis of eccrine spiradenoma. They were observed in eight of nine eccrine spiradenomas but not in syringomas, nodular basal cell carcinomas, or glomangiomas. Perivascular spaces in spiradenomas consisted of variably sized spaces around one or more central blood vessels, bordered at the periphery by a palisade of tumor cells and lined at both sides by basement membrane collagen type IV. Perivascular spaces contained variable numbers of T lymphocytes in all cases and could undergo fibrosis, cystic dilatation, or hyalinization. In analogy to similar structures in thymomas, we suggest that perivascular spaces in spiradenomas are involved in the traffic of lymphocytes toward the tumor.

Devascularization of craniofacial tumors by percutaneous tumor puncture

PURPOSE

To present and evaluate a devascularization technique for hypervascular tumors of the head and neck by direct tumor puncture.

METHODS

Tumor puncture was performed percutaneously or via natural orifices (nose and mouth). In one case, an intrasellar tumor was embolized via a transseptosphenoidal surgical approach. The embolization material used was NBCA, lipiodol, and tungsten in the majority of tumors (14 out of 17) and alcohol for 3 metastases of the calvarium. We used this technique to embolize 10 nasopharyngeal fibromas, 4 tumors of the calvarium (3 metastases and 1 hemangiopericytoma), 1 intrasellar hemangiopericytoma, and 2 glomus tumors. Reflux of blood was obtained in every case after direct puncture of the tumor. Direct injection of contrast agent into the tumor revealed local parenchymography followed by local and regional venous drainage without extravasation.

RESULTS

Total devascularization was obtained in 14 cases, and devascularization greater than 90% was obtained in 3 cases. Thirteen tumors were totally resected without requiring blood transfusion. During surgery, the limits of the exsanguinated tumor were very well defined in every case by the black staining induced by tungsten. Of the 4 tumors embolized but not operated on (3 metastases and 1 glomus tumor), 2 metastases needed retreatment after 6 and 8 months of remission, respectively. The other metastasis is still in remission after 3 months, and the volume of the glomus tumor decreased by 80% remains unchanged after 8 months.

CONCLUSION

This technique was initially used to devascularize tumors with difficult or dangerous intravascular access, but in view of the hemodynamic and surgical results obtained, we believe that the indications for this technique can be extended to hypervascular tumors accessible to conventional embolization.

Glomus tumor in children (description of one case)

Glomus tumor is a lesion of the soft tissues which rarely occurs in children. One case of the disease characterized by deep localization and atypical radiographic symptoms and manifestations is described.

[A glomus tumor of the stomach associated with a lipoma]

A case of Glomus tumor of the stomach associated with a lipoma in a 65-year-old female is reported. The patient complained of epigastralgia for three months prior to her admission. X-rays, as well as gastroscopic examinations, revealed two submucosal tumors, one located along the greater curvature of the gastric antrum and the other on the posterior wall of the upper corpus. A preoperative angiographic study showed hypervascularity and tumor staining. Histologically, one tumor was diagnosed as being Glomus tumor and the other, a lipoma. Thus this rare case of two submucosal tumors in the stomach is discussed and 39 previous gastric Glomus tumor cases found in the domestic literature are reviewed.