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The cryosurgical treatment of glomus jugulare tumours

THE first attempts to destroy tumours by local freezing techniques were made in 1851 by James Arnott, who worked in Brighton and London. Arnott irrigated several superficial tumours with an iced cold brine solution. It was not possible to achieve really cryogenic temperatures until the basic, and later the commercial techniques of liquifying gases had been evolved at the turn of the century. The next advance in cryosurgery was dependent upon an improvement in instrumentation so that the duration and intensity of the freezing process could be controlled accurately. The major breakthrough occurred when Cooper and Lee (1961) evolved a cryogenic system using liquid nitrogen with which the tip temperature of the probe could be reduced to —190" C. Subsequently cryosurgical techniques have been used quite frequently in an attempt to destroy tumours, and as an adjunct to surgical excision because of the haemostatic and cryo-adhesive properties of this modality. These two properties are of particular value in dealing with very vascular lesions such as the glomus jugulare tumour and can greatly simplify the treatment of what are quite frequently, difficult therapeutic problems. Orthodox surgical techniques are complicated by the vascularity of the lesion, by the close proximity of the jugular bulb and cranial nerves, and by the fact that erosion of bone and sometimes secondary infection can further expose these important structures and thus increase their vulnerability to surgical trauma. The tumours arising from the promontory are usually much easier to remove than those which arise from the jugular bulb. These tumours are not very radiosensitive. The first efforts to treat these lesions by cryosurgery were reported by Lewis and Cahan (1967), who treated five tumours, three of them were growing from the promontory, which were treated by initial freezing, followed by traction removal and finally by freezing the base of the tumour. These operations were performed easily and the amount of bleeding was minimal. There were no complications in this group. The other two tumours were arising from the jugular bulb and traction removal was impossible. It was however, possible to destroy both these tumours by cryo-necrosis. The first case was complicated by a temporary facial palsy and the second by a tympanic perforation. House and Glasscock (1968) and Hanckel (1967) also reported favourably on the use of cryosurgery in the treatment of this disease.