[Glomus jugulare tumor: perioperative management].
Surgical treatment of glomus jugulare tumors yields high rates of perioperative morbidity and mortality for several reasons, among them neuroendocrine secretory activity, a high degree of vascularization, intracranial extension, duration of surgery and cranial nerve lesion. Secretory activity (e.g. catecholamines and serotonin) should be investigated before surgery and treated appropriately. Carotid arteriography (and ball occlusion) are useful to assess vascularization of the tumor and determine the need to clamp the carotid artery during the procedure. Potential complications such as hemodynamic alterations (bleeding or endocrine response), pulmonary embolism (air or thrombotic), hypothermia, facial nerve lesion, should be monitored for during surgery. After surgery cranial nerve involvement, which can lead to dysphagia and bronchoaspiration, must be looked for; the risk of cerebro-spinal fluid fistula is also high. We report the case of a woman who underwent surgery for a non secreting glomus jugulare tumor with extradural intracranial invasion. The main complications during surgery were bleeding with hemodynamic repercussions, pulmonary embolism, lesions in the VII, VIII and X cranial nerves, and opening of the dura mater (which required insertion of an intradural drain to prevent formation of a fistula). After surgery oral intake was delayed until intestinal function was established and glottic sphincter competence was verified by fiberoptic laryngoscopy. The only complication presenting at this time was cephalea, which disappeared upon removal of the drain on day 4. The patient was released on day 10.
Ferrando
A
A
Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid.
Fraile
J R
JR
Bermejo
L
L
de Miguel
A
A
Aristegui
M
M
Hervías
M
M
Quirós
P
P
D002404:Catheterization; D005260:Female; D005402:Fistula / Q000517:prevention & control; D005925:Glomus Jugulare Tumor / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care; D013355:Subdural Space