Successful resection of an extensive type C1 glomus jugulare tumor involving the jugular foramen and petrous bone: A case report and literature review.

INTRODUCTION: Glomus jugulare tumors are rare, highly vascular paragangliomas arising within the jugular foramen. They are typically slow-growing but can cause significant morbidity due to involvement of surrounding neurovascular structures. Optimal management requires a tailored approach based on the extent of the tumor, symptoms, and patient-specific factors.

CASE PRESENTATION: A 60-year-old woman presented with a seven-year history of progressive left-sided hearing loss, pulsatile tinnitus, and a sensation of fullness. She had undergone a previous cortical mastoidectomy with no symptomatic improvement. Otoscopic examination revealed a pulsatile, reddish mass in the external auditory canal. Imaging confirmed a large, hypervascular mass occupying the left jugular foramen with extension into the middle ear, petrous bone, parapharyngeal space, and partial erosion of the carotid canal. Diagnostic angiography revealed dominant arterial supply from branches of the external carotid artery.

CLINICAL DISCUSSION: Given the lesion's size, anatomical extension, prior surgical failure, economic situation, and ongoing symptom progression, observation or radiotherapy alone were deemed insufficient. The patient underwent preoperative embolization followed by complete tumor excision via a canal wall down mastoidectomy. Intraoperative facial nerve monitoring was employed. Postoperatively, the patient experienced no neurological deficits or recurrence during 2.5 years of follow-up.

CONCLUSION: This case illustrates the effectiveness of surgical resection in managing advanced glomus jugulare tumors when supported by detailed imaging, vascular mapping, and perioperative planning. In selected patients with expanding symptomatic lesions, surgery remains a viable curative option, particularly when combined with embolization and nerve preservation strategies.