Glomus jugulare are benign, slow growing tumors with capability of invading surrounding structures over time. These very hypervascular tumors, originate from cells called chemodetectors, measuring blood quality in the wall of the jugular vein. They are usually sporadic (non-hereditary) but very rarely seen as a part of the hereditary multiple neuro-endocrine tumors.
Epidemiology and Natural History:
These tumors most commonly appear in the middle age. Their rate in the general population is just under one in a million and found between 3 to 5 times more commonly in women.
Because of their indolent growth they are usually diagnosed at a large size or incidentally on MRI scans. The most common presentation is pulsatile tinnitus. This is when patients are able to hear their pulse CONSTANTLY in one ear. The pulsation sound usually does not disappear with gentle pressure on the neck.
Like many other benign, slow-growing tumors of the skullbase, the treatment of the glomus tumors is either watchful-waiting, microsurgical resection, or stereotactic radiation therapy. The important considerations include patient’s age, other medical co-morbidities, symptoms, size of the tumor, and individual preferences of the patient.
Watchful waiting is a very reasonable option in elderly patients, or patients with multiple medical problems. Since these tumors grow very slowly annual MRI scans could determine the rate of growth and need for intervention.
Microsurgical treatment of these tumors is usually done through a transjugular craniotomy approach. Please refer to Surgical Treatment Section for further details of the operation. Many of these tumors at the time of diagnosis have grown beyond the confines of the jugular bulb and into neurovascular structures. For this reason degree of resection of these tumors need to be balanced with possible side effects of aggressive surgical resection. At times, an aggressive attempt at complete resection of these tumors may lead into complete paralysis of the nerves responsible for voice, swallowing and shoulder extension on the side of the tumor. In many instances, surgeons elect to leave small piece of these tumors behind and follow them over time by MRI scans and use stereotactic radiation therapy in case of growth.
Stereotactic radiation therapy has over time become more acceptable as a method of treatment for these tumors. Few institutions now have adequate number of treated patients with long enough follow up to determine the efficacy of this treatment. As mentioned these tumors may grow incredibly slowly so unless they are followed for at least 5-10 years, one may not be able to measure correct efficacy. The other factor is that because of slow rate of growth, the neurovascular invasion of these tumors are at times completely compensated by the body. For this reason, only with objective measurement of these structures, such as the voice box, one can know if the radiation therapy actually halted the growth or also stopped it from invading structures already involved by the tumor.
 Suárez C, Rodrigo JP, Bödeker CC, et al. Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy. Head Neck. 2012 Mar 16.
 Pollock BE. Stereotactic radiosurgery in patients with glomus jugulare tumors. Neurosurg Focus. 2004 Aug 15;17(2):E10.