Available online 9 January 2013
Publication year: 2013
Source:World Neurosurgery
Background Otorrhagia is an uncommon but severe symptom of patients with large glomus jugulare tumors that erode through the tympanic membrane. In this case report we describe the use of transarterial embolization for long-term palliative management of otorrhagia in a patient with an unresectable glomus jugulare tumor. Case description A 53-year-old female presented with intermittent otorrhagia 10 years after subtotal resection of a glomus jugulare tumor. Follow-up MRI showed progressive enlargement of the tumor with significant extension into the posterior fossa. Resection was thought to be impractical, so transarterial embolization was offered as a palliative measure to help reduce the frequency and severity of bleeding episodes. Results Long-term control of otorrhagia was achieved after three rounds of intra-arterial embolization. In round one, the tumor was embolized from multiple ECA feeding branches using PVA particles. In round two, the ICA was sacrificed by embolizing the cavernous and petrous segments with coils. In round three, persistent feeders from the cervical ICA were embolized with Onyx. In 6 years of clinical follow-up, the patient has had no otorrhagia or new neurological deficits. Serial MRI shows there has been no significant interval tumor growth. Conclusion Long-term control of otorrhagia from glomus jugulare tumors can be safely achieved by intravascular embolization with Onyx.
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