Surgical Treatment of Glomus Jugulare Tumours:With special reference to the diagnostic value of retrograde jugnlarography

Abstract

Retrograde jugularography has been performed in 12 cases of glomus jugulare tumour. No less than 6 of them showed intravascular growth of the tumour, both in the jugular bulb and from the bulb into the internal jugular vein. In 3 of the 12 cases this examination disclosed compression of the jugular bulb and sigmoid sinus, indicating hypotympanic growth of the tumour. In view of these findings, a completely different surgical procedure to that currently used has been devised. The internal jugular vein, jugular foramen and jugular bulb are exposed, and the tumour tissue in and around the bulb removed in connexion with radical mastoid operation. Complicating bleeding can be decreased by ligation of the external carotid artery and effective packing of the sigmoid sinus, inferior petrosal sinus, emissary veins and collaterals. An account is given of four typical cases of intravascular invasion by the tumour and three cases of hypotympanic growth. Bulbectomy is recommended in all operable cases in which hypotympanic growth is present. Information about hypotympanic and intravascular growth of the tumour can be obtained preoperatively by means of retrograde jugularography.