Glomus Tumors

Historical studies have shown only 29% surviving 10 years in patients with glomus jugulare tumors managed with a variety of modalities ranging from no treatment to craniotomy with radiotherapy. Surgical excision offers a potential cure in the treatment of these patients. We advocate a combined trans and infratemporal approach to Type C (tympanomastoid with infralabyrinthine or petrous apex destruction) and D (intradural extension) tumors as described by Fisch. Pre-operative angiography with tumor embolization, where possible, is mandatory. Preliminary control of the internal carotid artery, the sigmoid sinus and the cavernous sinus is necessary to avoid a vascular catastrophe. Blind sac closure of the external auditory canal is performed, followed by a radical mastoidectomy. This exposes the middle and posterior fossa dura and the venous sinuses. The facial nerve distal to the geniculate ganglion is fully skeletonized and transposed anteriorly when necessary. A wide dural opening, sometimes in combination with transection of the sigmoid sinus and the tentorium cerebelli, is performed. The infralabyrinthine petrous bone needs to be removed to expose the petrous portion of the carotid artery and the jugular bulb. The intradural tumor is dissected using a technique of capsular diathermy and sharp dissection. The lower cranial nerves are frequently inseparable from the tumor in the region of the posterior lacerate canal (jugular foramen). The jugular vein is divided and the attachment of the tumor to the carotid artery is removed. This portion of the dissection may be quite hemor-rhagic because of the contribution of carotico-tympanic vessels to the tumor circulation. Once the tumor has been removed, time needs to be spent effecting a watertight closure.

One or more of the lower cranial nerves were sacrificed in 40% of patients in the Cambridge series. However, patients showed a remarkable ability to accommodate to the neurological deficit [6]. Whilst dysphonia was initially a problem in 6/15 patients, Teflon injection or thyroplasty significantly alleviated symptoms such that it was a persisting problem in only one patient. Persistent dysphagia was a feature in only two patients. Both were treated with a feeding gastrostomy. The remarkable tolerance of these patients to cranial nerve sacrifice may

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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