血管塞栓術を行わずに摘出した鼓室型グロームス腫瘍の2例

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  • Two Cases of Glomus Tympanicum Surgically Treated without Embolization
  • 臨床 血管塞栓術を行わずに摘出した鼓室型グロームス腫瘍の2例
  • リンショウ ケッカン ソクセンジュツ オ オコナワズ ニ テキシュツ シタ コシツガタ グロームス シュヨウ ノ 2レイ

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The glomus tympanicum is a vascular-rich tumor arising in the tympanic cavity. There is still an argument regarding treatment, especially the necessity of preoperative embolization. We report on two cases of glomus tympanicum which were surgically treated via two different approaches without preoperative embolization.<br> Case 1: A 28-year-old female had pain of the right temporal region with ipsilateral hearing loss lasting over 4 months. Her right eardrum was seen bulging and was pulsatile. High resolution CT and MRI with gadolinium confirmed a vascular-rich tumor localized in the meso-and hypotympanum. These findings lead us to a diagnosis of glomus tympanicum. Tentative removal of the posterior canal wall in addition to the facial recess approach enabled us to achieve total removal of the tumor with a small amount of blood loss (44 ml).<br> Case 2: A 69-year-old female had a right pulsatile tinnitus and hearing loss over 8 years. Her right eardrum was remarkably hyperemic and presented with pulsation. CT and MRI, even without the use of gadolinium due to bronchial asthma, demonstrated an intratympanic tumor and mastoid granulation. The transcanal approach was selected with the aim of mastoid cells preservation for middle ear ventilation. Posteroinferior drilling of the tympanic annulus, chorda tympani transection, tentative removal of the incus, and malleus handle amputation provided us with better access to control the tumor, even though some difficulty was still encountered in working in the tympanic sinus and hypotympanum. The amount of blood loss was 70 ml.<br> In the present cases, different approaches were selected to remove the intratympanic glomus tumor with a similar extension. In both approaches, the intraoperative bleeding was relatively easily controlled, and these results may support the lack of necessity for preoperative embolization. From our experience, the facial recess approach combined with tentative removal of the posterior canal wall is considered safer to control glomus tumors extending into the tympanic sinus and hypotympanum.<br>

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