2026 Poster Presentations
P092: NAVIGATING THE COMPLEXITIES OF SKULL BASE PARAGANGLIOMAS: CASE REPORT AND OVERVIEW WITH EMPHASIS ON MULTI-DISCIPLINARY APPROACH TO DIAGNOSIS AND MANAGEMENT
Jayesh Gupta, MD; Prashant Vempati, MD; Sepideh Amin-Hanjani, MD; Adel Azghadi, MD; Grayson Cole, DDS; Claire M Gleadhill; Madelyn N Stevens, MD; Ann K Jay, MD; University Hospitals/Case Western Reserve University
Background: Paragangliomas are rare neuroendocrine neoplasms derived from neural crest cells1. Skull base paragangliomas, or glomus tumors, are less common than other skull base masses such as meningiomas, however, they are the most prevalent tumor of the jugular foramen2. Their location adjacent to critical neurovascular structures, high vascularity, and locally aggressive behavior requires collaboration between an experienced multidisciplinary team3.
Purpose: We present the imaging findings of a rare case of glomus jugulotympanicum with extensive vascular invasion into the internal jugular vein, which has to date, only been described in a few case reports4. The purpose of this exhibit is to highlight the diagnostic and management considerations of glomus tumors from a multidisciplinary team.
Methods: With Institutional Review Board approval, a retrospective search of our institution's database was performed for skull base paragangliomas from 2021-2025. Imaging studies, including CT, MRI and DOTATATE-PET, as well as radiation planning datasets and pathologic specimens, were reviewed. Clinical records, operative notes, and intraoperative images were also examined.
Results: CT, MR, and DOTATATE-PET findings demonstrated a rare case of glomus jugulotympanicum with extensive invasion into the internal jugular vein. Representative imaging, along with pathologic specimens, is used to illustrate typical appearances of glomus tumors and to distinguish them from common mimics. Clinical considerations from otolaryngology, neurosurgery, and radiation oncology perspectives are discussed.
Conclusion: Skull base paragangliomas pose diagnostic and therapeutic challenges due to their vascularity, locally aggressive nature and involvement of critical neurovascular structures. Optimal outcomes require a multidisciplinary approach that integrates neuroradiology, pathology, otolaryngology, neurosurgery and radiation oncology expertise to ensure accurate diagnosis and effective management.
References:
Ikram A, Rehman A. Paraganglioma [Internet]. U.S. National Library of Medicine; 2024 [cited 2025 Sept 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549834/
Fayad JN, Keles B, Brackmann DE. Jugular foramen tumors. Otology &Neurotology. 2010 Feb;31(2):299–305. doi:10.1097/mao.0b013e3181be6495
Hu K, Persky MS. Treatment of head and Neck Paragangliomas. Cancer Control. 2016 Jul;23(3):228–41. doi:10.1177/107327481602300306
Avramovic N, Weckesser M, Velasco A, Stenner M, Noto B. Long distance endovascular growth of Jugulotympanic paraganglioma evident in 68ga-dotatate pet but concealed on CT. Clinical Nuclear Medicine. 2017 Feb;42(2):135–7. doi:10.1097/rlu.0000000000001476
Images 1 and 2: Contrast enhanced sagittal CT image and corresponding coronal GA-68 DOTATATE PET-CT a glomus jugulotypanicum extending into and expanding the internal jugular vein.
Image 3: Coronal CT in bone window shows a destructive mass in the left skull base extending into the middle ear cavity. Even though glomus paragangliomas are benign lesions, they cause aggressive bony erosion due to their vascular nature.