0:01

The last of the paragangliomas that occur below

0:04

the skull base is the glomus vagale.

0:07

So we have the most common being

0:09

carotid body tumor,

0:11

the next most common being glomus

0:13

jugulare and the least common being glomus

0:16

vagale. Remember also that the fourth one,

0:20

glomus tympanicum,

0:21

occurs in the temporal bone and is really

0:23

not considered a neck lesion per se.

0:27

These usually will occur behind

0:28

the angle of the mandible.

0:30

You notice that the angle of the mandible is

0:31

also the marker for the carotid bifurcation

0:34

region and therefore these are associated with the

0:38

C3 level and they go up to the skull base.

0:42

Two-thirds of them are going to be suprahyoid

0:46

and they will displace the internal carotid

0:48

artery in a different way than

0:50

the carotid body tumor.

0:51

That usually being intermediately displacing the

0:54

ICA and ECA and laterally displacing the jugular

0:57

vein. So between the two, there is

1:00

a small rate of malignancy in these

1:03

head and neck paragangliomas.

1:05

What I'm demonstrating here and what we will see

1:07

later is the course of the vagus nerve with the

1:13

various ganglia associated with the vagus nerve

1:16

because the glomus Vagale is associated with the

1:19

vagal paraganglionic tissue that

1:21

occurs along the vagus nerve.

1:24

And you can see that these little black dots

1:26

here showing the location of those paraganglioma

1:30

tissues. Here is a case of a patient who

1:34

had a very large glomus Vagale.

1:37

I'd estimate this to be at about

1:39

the C3 level right here.

1:41

And you can see the flow voids within the tumor.

1:45

And the tumor goes up to the skull base.

1:47

We'd have to look at the positioning

1:51

of the carotid arteries,

1:52

the external and internal carotid arteries, to

1:55

determine whether this represents a Glomus

1:57

Vagale tumor, usually centered.

2:00

A little bit higher or whether this is a carotid

2:03

body tumor that's growing up to the skull base.

2:06

In any case, it has all the features of a paraganglioma.

2:10

Why is this not a glomus jugulare?

2:14

As you can see,

2:14

it's kind of stopping at the skull base and

2:17

is not involving the jugular foramen.

2:19

And we'd also want to look at the jugular vein

2:22

and make sure that it is not being

2:24

infiltrated by the tumor.