Glomus Jugulare Tumors Workup

Updated: Dec 07, 2022
  • Author: Ryszard M Pluta, MD, PhD; Chief Editor: Brian H Kopell, MD  more...
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Approach Considerations





Imaging Studies

Plain skull radiography may show enlargement of the lateral jugular foramen and fossa. Axial and coronal computed tomography (CT) scanning with thin sections are superior at demonstrating the extent of bone destruction. Magnetic resonance imaging (MRI) with gadolinium-diethylenetriamine pentaacetic acid (DTPA) contrast is the best imaging study for delineating tumor limits. Glomus tumors on T1- and T2-weighted MRI have characteristic soft tissue mixed intensity with intermixed high-intensity signals and signal voids (ie, salt and pepper appearance) representing fast flowing blood. A combination of CT scanning and contrast MRI is the imaging regimen of choice for glomus jugulare tumors. [5]

Unless carotid arteriography is necessary for preoperative evaluation and/or embolization, noninvasive techniques are preferred; however, for large tumors involving the internal carotid artery (ICA), preoperative carotid arteriography with cross-compression or trial balloon occlusion is recommended. The venous drainage systems also need to be carefully studied before sinus occlusion is carried out during surgical resection.

For tumors with large intracranial extension, vertebral arteriography is advised to exclude arterial feeders from the posterior circulation.


Other Tests






The Glasscock-Jackson and Fisch classifications of glomus tumors are widely used. Staging is as follows [26] :

  • Type A - Tumor limited to the middle ear cleft (glomus tympanicum)

  • Type B - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement

  • Type C - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the petrous apex

  • Type C1 - Tumor with limited involvement of the vertical portion of the carotid canal

  • Type C2 - Tumor invading the vertical portion of the carotid canal

  • Type C3 - Tumor invasion of the horizontal portion of the carotid canal

  • Type D1 - Tumor with an intracranial extension less than 2 cm in diameter

  • Type D2 - Tumor with an intracranial extension greater than 2 cm in diameter