Anaesthesia for catecholamine-secreting glomus jugulare tumor resection

Glomus jugulare tumors (GJT) are benign locally aggressive, highly vascular tumours originating from paraganglia cells of jugular bulb. Rarely these tumors are secretory and are often surgically resected to regulate the systemic effects of the catecholamine or serotonin secretion. Anaesthetic management of such cases is very challenging due to myriad effects of tumor secretion on one hand and its unique location on the other hand. Diagnosis of secretory GJT is established after biochemical confirmation and imaging. Early multidisciplinary involvement of endocrinology, anaesthesiology, and endocrine surgeon for catecholamine secreting tumors is desirable for successful perioperative management. Adequate preoperative optimization, provision of stable hemodynamics in the face of catecholamine surges or carcinoid-like syndrome (especially at laryngoscopy, intubation, surgical stimulation, and tumor handling) followed by reverse situation after tumor ligation are major challenges. Unique anatomical location may necessitate measures to control intracranial pressure, intraoperative blood loss and additional nerve monitoring. This review attempts to comprehensively address the preoperative management of these challenging tumors.