title: Successful Onyx embolization of a giant glomus jugulare: case report and review of nonsurgical treatment options.
abstract: 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.
  
  
  METHODS
  A 53-year-old woman presented with intermittent otorrhagia 10 years after subtotal resection of a glomus jugulare tumor. Follow-up magnetic resonance imaging showed progressive enlargement of the tumor with significant extension into the posterior fossa. Resection was thought to be impractical; therefore, 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 external carotid artery feeding branches by the use of polyvinyl alcohol particles. In round two, the internal carotid artery was sacrificed by embolizing the cavernous and petrous segments with coils. In round three, persistent feeders from the cervical internal carotid artery were embolized with Onyx. In 6 years of clinical follow-up, the patient has had no otorrhagia or new neurological deficits. Serial magnetic resonance imaging revealed there has been no significant interval tumor growth.
  
  
  CONCLUSIONS
  Long-term control of otorrhagia from glomus jugulare tumors can be safely achieved by intravascular embolization with Onyx.
authors: Division of Neurosurgery, Albany Medical Center, Albany, New York, USA.
authors: John C
authors: JC
authors: Dalfino
authors: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Doniel
authors: D
authors: Drazin
authors: Division of Neurosurgery, Albany Medical Center, Albany, New York, USA.
authors: Anil
authors: A
authors: Nair
authors: Division of Neurosurgery, Albany Medical Center, Albany, New York, USA.
authors: Edward
authors: E
authors: Gifford
authors: Division of Neurosurgery, Albany Medical Center, Albany, New York, USA. Electronic address: BoulosA@mail.amc.edu.
authors: Alan S
authors: AS
authors: Boulos
mesh_terms: D002558:Cerebrospinal Fluid Otorrhea / Q000473:pathology / Q000628:therapy; D004121:Dimethyl Sulfoxide; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005924:Glomus Jugulare / Q000473:pathology*; D005925:Glomus Jugulare Tumor / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011145:Polyvinyls; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Embolization, therapeutic; Endovascular procedures; Glomus jugulare tumor; Onyx copolymer; Paraganglioma