Targeted palliative endovascular embolization of a glomus jugulotympanicum tumor for refractory Jacobson's neuralgia: A case report.

Abstract

Background: Glomus tumors around the jugular foramen and inner ear can have variable presentations, including lower cranial nerve palsies, tinnitus, hearing loss, or palpable neck mass. In general, these tumors are benign paragangliomas with the definitive treatment consisting of radiosurgery or surgery. Endovascular embolization can be added as a critical adjunctive therapy to reduce the tumor vascularity before surgical resection. We present the first case of a glomus jugulotympanicum presenting with a severe otalgia-dominant form of glossopharyngeal neuralgia, Jacobson's neuralgia, that was resistant to radiosurgery and relieved successfully by targeted endovascular embolization.

Case description: A 51-year-old female presented with worsening right-sided lancinating ear pain radiating into the jaw and neck, exacerbated by brushing her teeth or any pressure on the skin - consistent with glossopharyngeal neuralgia, Jacobson's variant. Imaging revealed a dumbbell-shaped heterogeneously-enhancing mass in the middle ear cavity extending through the jugular foramen consistent with a glomus jugulotympanicum tumor. After treatment with single-fraction stereotactic radiosurgery, the neuralgia continued to worsen despite medical management and significantly impacted the patient's quality of life. After a multidisciplinary discussion, we performed targeted endovascular embolization of the tumor as palliative therapy. The patient subsequently reported complete relief of neuralgia and full resolution of tinnitus after the embolization procedure, remaining pain free at 20 months follow-up.

Conclusion: Targeted endovascular embolization may serve as a safe and potentially palliative option for refractory Jacobson's neuralgia induced by a glomus jugulotympanicum tumor.