Glomus jugulare tumour
Middle aged lady presented with sensorineural hearing loss, tinnitus and vertigo.
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Intensely enhancing hyperdense lesion is seen involving the left jugular foramen, measuring approximately 3.5 x 3.5 x 3.5 cm. The lesion is causing destruction and widening of the jugular foramen.
Medially the lesion has intracranial extra dural extension in the posterior fossa indenting the cerebellar cortex.
Laterally the lesion is extending in the middle ear cavity (epi, meso and hypotympanum)and external auditory canal. There is erosion of the long process of incus, inferior semicircular canal and the basal turn of cochlea and the lateral wall of tympanic segment of facial nerve.
Lesion is infiltrating the jugular bulb and inferiorly extending into the proximal jugular vein. Posterior inferiorly there is destruction of the basi occiput and lateral aspect of foramen magnum.
The most common tumor to develop in the jugular foramen is a paraganglioma (glomus jugulare). Paragangliomas in the skull base are ubiquitous in their distribution and arise from paraganglia or glomus cells situated at the following sites:
(1) in the adventitia of the jugular bulb beneath the floor of the middle ear
(2) in the bony walls of the tympanic canals related to the tympanic branches of the IX and X nerves
(3) in the bone of the promontory, close to the mucosal lining of the middle ear.
Imaging studies are necessary to depict the location and extent of tumor involvement, to help determine the surgical approach, and to predict operative morbidity and mortality.1
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