最新 Glomus jugular tumor 课件医学课件

1、Glomus jugular tumor2021/4/261Background Originate from chemoreceptor jugular veinglomus jugulare tumor is arisen in the adventitia of the dome of the jugular bulbThis tumor is part of the neuroendocrine system, these tumors are highly vascularized.Glomus tumors represent 0.6% of neoplasms of the he

2、ad and neck2021/4/262Pathology All paraganglia are composed of chief cells (type I cells, ie, chemoreceptive cells) and sustentacular cells (type II cells, ie, supporting cells). Developmentally, both types of cells are of neuroectodermal origin; specifically, they arise from neural crest cellsThe v

3、ast majority of glomus tumors are benign and slow to grow with bone erosion.2021/4/263Pathology Glomus jugulare tumors are typically located just under the skull base, at the bulb of the internal jugular vein. The tumors may spread superiorly into the jugular foramen, causing CN IX, CN X, and CN XI

4、deficits. The primary blood supply to jugulare tumors is via the ascending pharyngeal artery. In addition, the occipital and posterior auricular arteries can contribute to vascularization. Intraoperatively ligation of external carotid artery can significantly reduce the hemorrhage2021/4/264Symptoms

5、Pulsatile tinnitus, Conductive hearing loss, aural bleeding, and aural discharge.Sensorineural hearing loss, vertigo, aural pain and Cranial neuropathy. Such as it can compress CN IX, X, and XI. 2021/4/265Symptoms Functioning tumors, which are rare, can increase risk of mortality. These active tumor

6、s secrete catecholamines, which can lead to clinical manifestations of hypertension, headaches, palpitations, and tachycardia2021/4/266Signs Positive Browns sign.Aural polypCranial nerves involvement 2021/4/267Lab testsRoutine laboratory studies are not helpfulIn the rare patient with functioning le

7、sions, preoperative and postoperative catecholamine measures may help confirm successful resection of the lesion2021/4/268Image studyA combination of contrast-enhanced CT, MRI, and angiography is ideal for proper diagnosis and localization of the tumors.MRI Contrast-enhanced CT Angiography remains o

8、f paramount importance if the diagnosis is obscure or if embolization is planed. 2021/4/269CTGlomus jugulare tumors are enhancing soft-tissue masses at the skull base, but skull-base artifact can mask their presence. These tumors are seen within the jugular foramen.The demonstration of bone erosion

9、of the jugular foramen and petrous apex is often a key finding in the diagnosis. Careful review of bone windows is necessary. 2021/4/26109、 人的价值，在招收诱惑的一瞬间被决定。2022/7/122022/7/12Tuesday, July 12, 202210、低头要有勇气，抬头要有低气。2022/7/122022/7/122022/7/127/12/2022 9:02:46 PM11、人总是珍惜为得到。2022/7/122022/7/122022/7/1

10、2Jul-2212-Jul-2212、人乱于心，不宽余请。2022/7/122022/7/122022/7/12Tuesday, July 12, 202213、生气是拿别人做错的事来惩罚自己。2022/7/122022/7/122022/7/122022/7/127/12/202214、抱最大的希望，作最大的努力。12 七月 20222022/7/122022/7/122022/7/1215、一个人炫耀什么，说明他内心缺少什么。七月 222022/7/122022/7/122022/7/127/12/202216、业余生活要有意义，不要越轨。2022/7/122022/7/1212 July

11、 202217、一个人即使已登上顶峰，也仍要自强不息。2022/7/122022/7/122022/7/122022/7/12MRIIt can show intense tumor enhancement, and is a key finding in the diagnosis. A salt-and-pepper fine vascular pattern can be seen in the tumors; this finding is suggestive of intrinsic tumor neovascularity, particularly on T2-weighted

12、 images. 2021/4/2612MRIImages show that enhancing soft-tissue masses protrude both intracranially and extracranially at the skull base. Coronal imaging can show tumoral relationships to the brainstem and skull base, and deep cervical soft-tissue structures2021/4/2613AGDemonstrating the feeding arter

13、yJugulare tumors involve higher external carotid branch vessels; the ascending pharyngeal, tympanic, and occipital arteries dominate the arterial blood supply. Arteriovenous fistulae may be present. Rarely, the internal carotid and vertebral arteries may contribute feeders to the neoplasms. Typicall

14、y, these tumors are evaluated, with attention paid to all potential feeding arteries. 2021/4/2614Contraindication Biopsy is prohibitive for patient with glomus jugular tumorDue potential hemorrhage 2021/4/2615Surgical Intervention Surgery is the preferred method of treatment for glomus tumors. Most

15、paragangliomas are slow-growing and benign, radiotherapy alone or no treatment at all is preferred in elderly patients in whom the risks of surgery are relatively high and the tumor is unlikely to cause serious morbidity or mortality. If the patient is young, surgery is the best option that allows t

16、otal cure.2021/4/2616Surgical InterventionCurrent techniques are highly successful with relatively low morbidity rates: Blood loss and CN neuropathies are the major complications. Depending on the specific type and location of the tumor, different surgical approaches are required. 2021/4/2617Surgica

17、l InterventionExtensive facial recess approach2021/4/2618Surgical InterventionMastoid neck approach: tumors are confined to jugular foramen and may extend to the middle ear and mastoid. They do not involve the carotid artery or the intracranial compartment.Infratemporal fossa approach: tumors involv

18、e in carotid artery and transdural tumor are far more extensive. 2021/4/26192021/4/2620Radiotherapy Gamma-knife irradiation is used in patients who are poor candidates for surgical excision or embolization due to their age or disease state or because of unacceptable morbidity. This procedure is expe

19、nsive, and clear remission is not reported. It can control the tumor and prevent it from growing larger. 2021/4/2621Embolization Embolization is a common technique used as the lone treatment option or as a precursor to surgical excision. Starving the lesion of its blood supply and inducing necrosis.

20、 embolization is often used to reduce blood loss, and it has been proven to be highly effective.Care must be taken to avoid inadvertent extracranial-intracranial embolization and the subsequent the risk of stroke2021/4/2622Thanks for your attention2021/4/26239、 人的价值，在招收诱惑的一瞬间被决定。12-7月-2212-7月-22Tuesday, July 12, 202210、低头要有勇气，抬头要有低气。*7/12/2022 9:02:46 PM11、人总是珍惜为得到。12-7月-22*Jul-2212-Jul-2212、人乱于心，不宽余请。*Tuesday, July 12, 202213、生气是拿别人做错的事来惩罚自己。12-7月-2212-7月-22*12 July 202214、抱最大的希望，作