頸靜脈球瘤 (glomus jugulare tumor) - 醫師

請問一下台灣哪位醫師對頸靜脈球瘤(glomus jugulare tumor)的處理比較有經驗的？

患者的瘤有點大 CT & MRI 的結果都指示超過 2.5 cm 且侵蝕部份頭骨

醫師建議放射線治療和手術雙管齊下 患者主訴有心搏性耳鳴 面部肌肉不自主抽動

吞嚥困難 暈昡 檢查時右耳道近鼓膜處有明顯小紅莓狀腫塊

可以幫忙解讀一下 CT & MRI 的報告嗎？ 如果有興趣看片子請私信

CT 報告如下:

THIS STUDY IS PERFORMED WITH 100 mL OF ISOVUE 300.

THERE IS AN INTENSELY ENHANCING DESTRUCTIVE TUMORE INVOVING THE RIGHT JUGULAR
BULB EXTENDING INTO THE MASTOID AIR CELL COMPLEX SUPERIORLY AND TO THE MIDDLE
EAR CAVITY AS WELL. IT EXTENDS INFERIORLY OVER A LENGTH OF 4.2 CM AND MEASURES
2.6 CM IN WIDTH. IT HAS SPECKLED, INTENSE ENHANCEMENT AS NOTED ON THE MRI,
FEATURES OF CLASSIC GLOMUS JUGULARE TUMOR.

ON THE CORONAL BONE WINDOW IMAGES AT 1MM THE TUMOR EXTENDS TO THE INFERIOR
MARGIN OF THE OTIC CAPSULE IT INVADES THE HYPOTYMPANUM AND IS INSEPARABLE FROM
THE TYMPANIC MEMBRANE. IT SHOULD BE VISIBLE ON OTOSCOPIC EXAMINATION. THE
PRUSSAK SPACE AND THE OSSICULAR CHAIN ARE INTACT. POSTERIORLY IT INVADES
MASTOID AIR CELL COMPLEX MEDIALLY THERE IS INVOLVEMENT OF THE JUGULAR BULB
WHICH IS EXPECTED.

THE LEFT TEMPORAL BONE IS NORMAL.

THERE IS A PEDUNCULATED RETENTION CYST IN THE RIGHT MAXILLARY SINUS AND
MUCOSAL IN THE INFERIOR LEFT MAXILLARY SINUS. THE NASAL PASSAGEWAY BOWS TO
THE LEFT. THERE IS A 6-MM OSTEOMA IN THE ANTERIOR LEFT ETHMOIDAL AIR CELL.
tHE FRONTAL SINUS, ETHMOIDAL AIR CELLS AND SPHENOID SINUS ARE AERATED.

IMPRESSION:

1. LARGE DESTRUCTIVE GLOMUS JUGULARE TUMOR. THERE IS BONY DESTRUCTION AS
DECSRIBED IN THE BODY OF THE REPORT. THE TUMOR INVADES THE HYPOTYMPANUM AND
EXTENDS TO THE TYMPANIC MEMBRANE. IT RESTS ALONG THE UNDERSURFACE OF THE OTIC
CAPSULE. IT EXTENDS INTO THE JUGLAR FORAMEN WHICH IS TO BE EXPECTED.

2. LEFT TEMPORAL BONE APPEARS NORMAL

========================== MRI 報告如下=============================

ENHANCED MRI OF THE BRAIN IS PERFORMED ON A 1.5 TESLA MAGNET.

THERE IS AN IRREGULAR ENHANCING TUMOR EXTENDING FROM THE RIGHT SKULL
BASE/GUGULARFORAMEN INFERIORLY OVER A HEIGHT OF 3.9 CM. ON THE AXIAL ENHANCED
IMAGES WITH CONTRAST AND FAT SUPPRESSION THERE IS INTENSE ENHANCEMENT WITH
SPECKLED INTERNAL FLOW-VOIDS WHICH IS A CLASSIC APPERANCE OF GLOMUS JUGULARE
TUMOR. THE TUMOR IS 2.9CM AP BY 2.5 CM IN WIDTH. THE RIGHT TRANSVERSE SINUS IS
PATENT. THE SUPERIOR RIGHT INTERNAL JUGULAR VEIN IS INSEPARABLE FROM THE TUMOR.

THERE IS FLUID IN THE RIGHT MASTOID AIR CELL COMPLEX ALMOST CERTAINLY FROM
BLOCKAGE OF THE EUSTACHIAN TUBE.

THE BRAIN PARENCHYMA IS NORMAL ON ALL SERIES. THIN SECTIONS IN THE POSTERIOR
FOSSA SHOW NORMAL 5TH, 7TH AND 8TH CRANIAL NERVES.

THERE IS A PEDUNCULATED 2.3-CM RETENTION CYST ARISING FROM THE ANTERIOR WALL
OF THE RIGHT MAXILLARY SINUS. THE NASAL SEPTUM DEVIATES TO THE LEFT. THE OTHER
PARANSAL SINUSES ARE NORMAL.

IMPRESSION:

1. THERE IS A LARGE RIGHT SKULL BASE GLOMUS JUGULARE TUMOR. DIMENSIONS ARE
PROVIDED IN THE BODY OF THE REPORT. THERE IS SKULL BASE DESTRUCTION WHICH IS
SEEN TO ADVANTAGE ON THE HIGH RESOLUTION CT WHICH IS PERFORMED ON THE SAME DAY.

2. THE BRAIN PARENCHYMA HAS NORMAL SIGNAL INTENSITY.

3. RETENTION CYST IN THE RIGHT MAXILLARY SINUS AND MUCOSAL THICKENING IN THE
INFERIOR LEFT MAXILLARY SINUS.

4. THERE IS SOME FLUID IN THE RIGHT MASTOID AIR CELL COMPLEX.


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