Wilson Brendan, Vivek Mithul, Na John, De Gregorio Andrea, Pater Luke, Muthana Ahmed, Hoz Samer S, Prestigiacomo Charles J
Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, United States.
Department of Neurosurgery, University of Milan, Milan, Italy.
Surg Neurol Int. 2024 Nov 22;15:433. doi: 10.25259/SNI_901_2024. eCollection 2024.
Glomus tumors around the jugular foramen and inner ear can have variable presentations, including lower cranial nerve palsies, tinnitus, hearing loss, or palpable neck mass. In general, these tumors are benign paragangliomas with the definitive treatment consisting of radiosurgery or surgery. Endovascular embolization can be added as a critical adjunctive therapy to reduce the tumor vascularity before surgical resection. We present the first case of a glomus jugulotympanicum presenting with a severe otalgia-dominant form of glossopharyngeal neuralgia, Jacobson's neuralgia, that was resistant to radiosurgery and relieved successfully by targeted endovascular embolization.
A 51-year-old female presented with worsening right-sided lancinating ear pain radiating into the jaw and neck, exacerbated by brushing her teeth or any pressure on the skin - consistent with glossopharyngeal neuralgia, Jacobson's variant. Imaging revealed a dumbbell-shaped heterogeneously-enhancing mass in the middle ear cavity extending through the jugular foramen consistent with a glomus jugulotympanicum tumor. After treatment with single-fraction stereotactic radiosurgery, the neuralgia continued to worsen despite medical management and significantly impacted the patient's quality of life. After a multidisciplinary discussion, we performed targeted endovascular embolization of the tumor as palliative therapy. The patient subsequently reported complete relief of neuralgia and full resolution of tinnitus after the embolization procedure, remaining pain free at 20 months follow-up.
Targeted endovascular embolization may serve as a safe and potentially palliative option for refractory Jacobson's neuralgia induced by a glomus jugulotympanicum tumor.
颈静脉孔和内耳周围的球瘤可表现多样，包括下颅神经麻痹、耳鸣、听力损失或可触及的颈部肿块。一般来说，这些肿瘤是良性副神经节瘤， definitive治疗包括放射外科手术或手术。血管内栓塞可作为一种关键的辅助治疗，在手术切除前减少肿瘤血管。我们报告首例颈静脉鼓室球瘤表现为以严重耳痛为主的舌咽神经痛（雅各布森神经痛），对放射外科手术耐药，经靶向血管内栓塞成功缓解。
一名51岁女性出现右侧耳部刺痛性疼痛加重，放射至下颌和颈部，刷牙或皮肤受压时加剧，符合舌咽神经痛（雅各布森变异型）。影像学检查显示中耳腔内有一个哑铃形不均匀强化肿块，延伸至颈静脉孔，符合颈静脉鼓室球瘤。单次分割立体定向放射外科手术后，尽管进行了药物治疗，神经痛仍继续恶化，严重影响了患者的生活质量。经过多学科讨论，我们对肿瘤进行了靶向血管内栓塞作为姑息治疗。患者随后报告栓塞术后神经痛完全缓解，耳鸣完全消失，随访20个月时仍无疼痛。
靶向血管内栓塞可能是颈静脉鼓室球瘤引起的难治性雅各布森神经痛的一种安全且可能有效的姑息治疗选择。
