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Glomus jugulare tumor embolization_1440

By Paul Hayes,2014-10-30 18:49
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Glomus jugulare tumor embolization_1440

Glomus jugulare tumor embolization

     Abstract Objective To evaluate the artery embolization treatment of right glomus jugulare tumor effect. Methods 3 cases confirmed by surgery and pathology in patients with glomus jugulare tumor, using Seldinger technique first super-

    selective catheterization and angiography clearly artery lesion, followed by infusion polyvinyl alcohol particles (PVA particles) amount. Embolism a week after surgical resection. Results 3 patients were embolization of tumor feeding arteries

    and tumor stain disappeared. Embolism Across surgery are complete resection and less bleeding. Follow-up Study after

    embolization, the patient's clinical symptoms were relieved or disappeared. Conclusion glomus jugulare tumor embolization in

    reducing blood loss and inhibiting tumor growth have a positive effect, preoperative embolization plus surgical resection is the treatment of glomus jugulare tumor in an effective way.

     Key words Glomus jugulare tumor embolization to intervene

     0 Introduction

     Glomus jugulare tumor is a jugular vein tympanic

    paraganglioma of the collectively referred to as belonging to chemodectoma because from adjacent ganglion cells, it is also known as the ganglion adjacent to tumors, mostly benign [1,2].

    Glomus jugulare tumor clinically rare, its location hidden, deep in, the symptoms are often associated with local symptoms similar to other diseases, so vulnerable to misdiagnosis and mistreatment. At present, for glomus jugulare tumors, most of

    them advocate surgical resection, but the glomus jugulare

    tumor blood supply is extremely rich, surgery is often a serious bleeding, on the one hand caused by large blood loss, on the other caused by surgical field blur, affecting operation to proceed, hinder the Important structure

    identification, caused by accidental injury. In order to

    reduce intraoperative blood loss, most scholars advocate preoperative embolization of vascular interventional OK [3

    6]. As the neurological maturity of interventional radiology, interventional embolization in reducing blood loss glomus

    jugulare tumor and inhibiting tumor growth have a positive effect. This paper summarizes the three cases of glomus jugulare tumor embolization of the initial experience.

     1 Data and methods

     Collected in June 2002 ~ June 2003 between the three

    cases of glomus jugulare tumor, all cases were confirmed by MRI and pathology, of which 2 males, 1 female, aged 38 to 43 years old, with an average 40.5 years of age. Duration of 6 to 28 months. Clinical manifestations are pulsatile tinnitus, no

    obvious incentive for the earache, hearing impairment or loss, facial palsy, incomplete eyelid closure, mouth deflection and so on.

     Adoption of the Dutch Philips Integris 3000 DSA device. Conventional preoperative preparation, anesthesia technique

    after seldinger the right femoral artery puncture, catheters were selected to the bilateral common carotid artery, vertebral artery angiography to clarify lesion size, shape, quantity, location, feeding arteries, etc., before taking any action super-selection intubation to the lesion side of the internal carotid artery, external carotid artery branch, first imaging, Across embolism. Embolization material selection diameter of 300 ~ 510μm particles of polyvinyl alcohol (PVA) amount, in the X-ray TV slowly into the lesion under the

    surveillance of feeding arteries, to review the imaging tumor stain not show up. 2 patients in the week after the surgical removal of embolism, and the other one cases of unsatisfactory results due to surgical and interventional embolization.

     2 Results

     3 cases of glomus jugulare tumors, 2 cases of left, right 1 case, 2 of them mainly by the left ascending pharyngeal artery, 1 case mainly by the right occipital artery branch blood stem nipples. Tumor stain disappeared after embolization of tumor feeding arteries are mostly embolism. 2 cases of surgical experts in the week after embolization, are completely removed, blood loss is about 100ml, significantly less than the other cases (before surgery did not

    interventional embolism) surgical bleeding was about 500ml. Pathological diagnosis Jugulotympanic paraganglioma, tumor necrosis and see some of thrombosis. Six months to one year after embolization follow-up observation, the patient's

    clinical symptoms were relieved or disappeared.

     Figure 1 tumor embolization before staining significantly (abbreviated)

     Figure 2 tumor stain disappeared after embolization (omitted)

     3 Discussion

     Glomus jugulare tumor is derived from the jugular bulb

    and middle ear tumor Paraganglioma, which has the following clinical features: Women more common, age of onset of 40-year-

    old, the course is long and slow progress, in order to pulsatile tinnitus or hearing loss, as the main clinical illnesses. Glomus jugulare tumor stroma rich in blood vessels, mostly for expansion of the thin-walled sinusoids, and even

    into the vascular tumor-like changes; can be gradually

    increased, violations of adjacent tissues. Glomus jugulare tumor growth with a multi-center, one or more sub-leaf growth

    characteristics, the leaf feeding arteries from different sources. Because glomus jugulare tumor blood supply is extremely rich, so when suspected clinical disease, generally does not advocate needle biopsy, one case confirmed the need

    for effective treatment [2]. Reposted elsewhere in the paper for free download http://

     At present, for glomus jugulare tumors, surgical resection is still the preferred treatment, but the bleeding is one of the problems demanding prompt solution, for the

    majority of clinicians advocate preoperative embolization. Pairs of suspected glomus jugulare tumors in patients with preoperative angiography to be OK, first bilateral common carotid artery and vertebral artery angiography to prevent the

    omission of multiple lesions, a clear lesion after superselective catheterization to the lesion side of the internal carotid artery, carotid arterial blood supply branch of re-imaging. Literature suggests that: glomus jugulare tumor feeding arteries are mainly the external carotid artery branches, such as the ascending pharyngeal artery, occipital artery, ear artery and so on, this group of patients in the two cases from the left ascending pharyngeal artery, and 1 case from the right side of occipital artery branch blood stem

    nipples. Glomus jugulare tumor angiography with a characteristic performance, it is not only a clear pathological morphology, but also a clear lesion size, number, location, feeding arteries, etc., for further treatment of embolization of great significance [7].

     Preoperative embolization in reducing blood loss and inhibiting tumor growth has a positive effect on a single branch of tumor blood supply, will embolus through the artery into the aneurysm filling the body, you can achieve better

    hemostasis effect and the purpose of inhibiting tumor growth ; for multi-branch feeding the tumor, should be carried out one by one for each artery angiography and embolization, if omitted then the surgery will still be bleeding, cancer will

    continue to grow. Embolization materials, a variety of options are common gelatin sponge particles, medical sutures, polyvinyl alcohol particles (PVA) and so on. Patients in this group are used specification is 300 ~ 510μm of PVA particles

    as the embolic material, we have achieved satisfactory results. As for the dosage of PVA should be flexibility by the surgeon, I believe that the end of indications for

embolization include: tumor blood flow feeding a much slower

    and there countercurrent; tumor stain disappeared.

     Reported in the literature [1], the scalp after embolization complications include pain, peripheral facial paralysis, glossopharyngeal nerve paralysis, the most serious complications are emboli countercurrent or "dangerous match," strayed into intracranial arterial cause neurological dysfunction. Embolization process, special attention should be dangerous match, to avoid ectopic embolization. Patients in this group due to the implementation of superselective

    embolization in the process of intubation and perfusion, and under the strict observation of X-ray TV embolization cases,

    strictly implementing the low-voltage slow perfusion, and

    therefore no case of mistaken bolt phenomenon.

     In summary, glomus jugulare tumors preoperative embolization in reducing blood loss and inhibiting tumor growth have a positive effect, preoperative embolization plus surgical resection is the treatment of glomus jugulare tumor in an effective way.

     References

     [1] Ling Feng. Interventional neuroradiology [M]. 1st edition. Beijing: People's Health Publishing House, 1991.162

     169.

     [2] Huang-liang, Yang Yan, Chou S, et al. Glomus jugulare tumor diagnosis and treatment [J]. Chinese Medical Journal,

    2002,82 (20): 1381 1384.

     [3] Tasar M, Yetiser S. Glomus tumors: therapeutic role of selective embolization [J]. J Craniofac Surg, 2004,15 (3): 497 505.

     [4] Marangos N, Schumacher M.. Facial palsy after glomus jugulare tumour embolization [J]. J Laryngol Otol, 1999,113 (3): 268 270.

     [5] LI Tie-lin, Duan Chuan-zhi, CHEN before. Huge glomus jugulare tumor a case of preoperative endovascular embolization [J]. Zhonghua Neurosurg, 1995,11 (1): 25.

     [6] Deng Gang, Xianglong, Shen naive, et al. Glomus jugulare tumor of the DSA performance and preoperative embolization [J]. Chinese Medical Computer Journal, 1996,2 (4): 258 260.

     [7] Wang Zhimin, Wang Su, Min-You, et al. Glomus jugulare tumor of the catheter treatment (report of 2 cases) [J]. Practical Radiology, 1995,11 (8): 506 507. Reposted

    elsewhere in the paper for free download Center http://

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