Small Size Glomus Jugulare Tumor

Abstract

A 38-year-old female presented asymptomatic, but with old, post-previous surgery, complete right sensorineural hearing loss, moderate right facial paresis, and mild right facial numbness. She had two prior craniotomies for glomus tumor 8 years and 4 years ago. The patient was treated with adjunctive; Linac-based SRS for regrowth of post-surgical residual, right, small size glomus jugulare tumor. The target volume of 3.8 cc received a marginal dose of 15.0 Gy normalized to 80% isodose line. Maximum dose to brain stem was 15.3 Gy. At 6 months post-SRS, the patient had improved facial numbness and worsened right facial paresis (severe). At 18 months post-SRS, the patient underwent surgical narrowing of the right palpebral fissure. At 24 months post-SRS, the patient underwent surgical anastomosis of the nerve to masseter muscle with the right facial nerve. Initial follow-up MRI showed a mild increase in tumor size and contrast enhancement. Thereafter, serial follow-up MRIs showed progressive decrease in tumor size and contrast enhancement. At last follow-up (78 months post-SRS), the patient had sustainable improvement of right-sided facial numbness and unchanged right-sided facial palsy, despite surgical nerve repair.