jugular glomus tumor
Introduction
Introduction to jugular bulbar tumor Jugular bulbar tumor is a tumor that occurs in and around the jugular foramen of the skull base. The course of disease varies from 1 month to 28 years. In the latter group, the cranial nerve is mainly involved, mostly single tumor, rarely familial. Genetic predisposition. The current treatment of the disease is the surgical removal of the tumor. Guilol and Rosenwasser (1940) first reported surgical resection of jugular bulbar tumors, but because of the rich blood supply to the tumor tissue, the local anatomy was complicated, which made it difficult to surgically remove the tumor. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: cerebrospinal fluid leakage meningitis dysphagia
Cause
The cause of jugular bulbar tumor
(1) Causes of the disease
Jugular bulbar tumor is a vascular-like tumor with spherical or nodular growth. The blood supply artery is from the lower tympanic ventricle of the pharyngeal ascending artery, and there is a scapular branch, the auditory artery, the occipital artery, the internal maxillary artery, the vertebral artery, and the internal hearing. Branch of the artery.
(two) pathogenesis
The tumor cells are mostly pleomorphic endothelial-like cells. The cytoplasm spreads eosinophilic fine particles. The nucleus is deeply stained in the center. The fibrous tissue divides the cells into nests, which pass through thin-walled small arteries and capillaries, and invasive growth and metastasis of tumors. Rarely, about 10% can spread to adjacent lymph nodes and lungs. The spread of tumor tissue is related to the obstruction of surrounding tissues. Some people think that the tumor spread pathway is: 1 along the eustachian tube and the skull base hole into the nasopharynx and the skull. Bottom, 2 along the internal carotid artery to the middle cranial fossa, 3 along the internal jugular vein and sublingual nerve hole into the posterior fossa, 4 along the tympanic membrane to the middle cranial fossa, through the labyrinth round window to the inner auditory tract cerebral horn Thus, it can be seen that the tumor grows in multiple places in the skull.
Fisch is divided into 4 types according to the size of the tumor and the extent of the invasion:
1. The tumor is confined to the ear.
2. The tumor is in the middle ear and involves the mastoid.
3. Tumor invasion is lost to the rock tip. This type includes:
(1) Although the tumor involved the jugular bulb and the jugular foramen, it did not invade the vertical portion of the carotid artery.
(2) The tumor affects the vertical part of the internal carotid artery.
(3) The tumor affects the horizontal part of the internal carotid artery.
4. Tumor invasion of the dura mater into the skull is further divided into:
(1) The tumor has an intracranial diameter of less than 2 cm.
(2) The diameter of the tumor is larger than 2 cm, and the intracranial part of the tumor is difficult to be removed.
Another person divides the tumor into the posterior cranial fossa through the jugular foramen and the tumor to destroy the skull and then enter the posterior fossa. The former lacks the dura mater structure due to the jugular foramen, and there is no dura mater between the tumor and the brain tissue. The latter tumor grows outside the dura mater, which is more common in clinical practice and has guiding significance for surgery.
Prevention
Jugular bulbar prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Jugular bulbar complication Complications Cerebrospinal fluid meningitis dysphagia
Postoperative complications include cerebrospinal fluid leakage, meningitis, dysphagia and facial paralysis. Carder reported 22 cases of transcranial approach, 2 patients with limited mastoid approach, 2 people under the tympanic approach, skull base approach and armpit 1 case of concave and cochlear approach, 13 patients underwent surgical resection, 8 patients were resected in stages, blood loss was between 600 and 800 ml, total tumor resection or near total resection was 20, and nearly total resection was performed. The comorbidity was: death , no; cerebrospinal fluid leakage, 4 cases; meningitis, 1 case; dysphagia, 11 cases; facial paralysis in 4 cases.
Symptom
Jugular bulbar symptoms Common symptoms Dizziness, cough, paralysis, repeated bleeding, dizziness, tinnitus, hoarseness, bone destruction, facial numbness, jugular vein filling
Early patients often have dizziness, dizziness and other symptoms, followed by repeated external ear canal bleeding, tinnitus, progressive deafness, late ear pain, facial paralysis, facial numbness, visual double into the body, the tumor is located near the jugular foramen, the latter group of brain Symptoms of nerve damage are hoarseness, water and cough, soft palsy on the affected side, pharyngeal reflex disappears, and when the tumor involves the middle and posterior fossa, some patients may have symptoms of temporal lobe, cerebellum and brainstem.
Examine
Examination of jugular bulbar tumor
1. Skull X-ray film
The jugular foramen can be seen as enlarged bone pores and bone destruction. When the tumor is large, there may be changes in the rock tip, middle cranial fossa, occipital foramen and internal auditory canal.
2. Head CT
It can be seen that the uneven and high-density shadow boundary of the jugular foramen is unclear. After the injection, the tumor is strengthened. For example, the tumor can be observed by the coronal artery of the internal carotid artery. The relationship between the tumor and the internal carotid artery can be observed. In X flat film.
3.MRI imaging
The effect of the skull base on the observation of the tumor can be eliminated. The relationship between the tumor morphology and the adjacent structure can be observed from the three directions of the sagittal, the crown and the axis. The tumor has an uneven signal of T1 and long T2, the contour is irregular, and the boundary is obviously strengthened after the injection. Clear.
4. Cerebral angiography
In the diagnosis of the disease is very important, carotid puncture cannulation, carotid artery or vertebral artery angiography can show abnormal early tumor staining, if the internal carotid artery, external carotid artery and vertebral artery selective tumor blood supply angiography is better See the contour of the tumor stained with blood vessels.
Jugular bulb angiography purposes:
1 Clear diagnosis.
2 understand the tumor feeding artery.
3 Except for carotid body tumor and vagus neuroma, prepare for preoperative embolization.
4 venous phase to determine the impact of tumor on the internal jugular venous return.
Diagnosis
Diagnosis and differentiation of jugular bulbar tumor
According to the symptoms and signs of cranial nerve damage and tinnitus and deafness in the patient's posterior group, combined with the skull and the CT of the jugular vein area shown by the head CT, the lesions of the jugular foramen can be considered, and the cerebral angiography sees the artery. Early abnormal staining contributes to the diagnosis of jugular bulbar tumors.
Differential diagnosis
Jugular vein vasculopathy
Including the jugular vein external convex dislocation deformity, the jugular bulb enters the lower tympanic cavity, the internal carotid artery is abnormal, the primary iliac artery, the middle ear internal carotid aneurysm, etc., the above lesions are confined to the middle ear, the skull is flat The slice and CT showed normal position of the bone holes in the skull base without bone and worm damage.
2. Non-vascularized tumors
Common schwannomas, skin and epidermoid cysts, inflammatory or non-inflammatory granuloma, chondrosarcoma, metastatic cancer, these tumors can also be expressed as 1/3 of the tongue after the loss of taste (glossopharyngeal nerve) vocal cords and soft palsy Symptoms of the jugular vein syndrome of the vagus nerve and the trapezius muscle and the sternocleidomast muscle (wean nerve), except for the skin-like or epidermoid cysts, CT scans of these tumors can show high-density shadows, but from the blood vessels There is very little early tumor staining as indicated by jugular bulbar tumors.
3. Meningioma
It can occur in the jugular foramen of the skull base. CT scans and angiograms may have signs similar to jugular bulbar tumors. However, meningioma may have calcification and local bone hyperplasia, while jugular bulbar tumors are bone. Quality damage is the main factor.
4. Tibia sarcoma
Often manifested as a wide range of skull destruction, a short course of disease, early multiple neurological damage, no jugular vein tumor damage in the order of cranial nerves.
