Guild, in 1942, identified tiny vascular structures at the dome of jugular bulb and promontorium and called them as glomera Jugulare [6]. Rosenwasser (1945) was the first to indicate the similarity and relationship between the glomus tumors and the glomus body [7].

Typically they occur in women in a 6:1 ratio and are mostly diagnosed in individuals ranging from 30 to 60 years of age. Familial occurrence is likely to occur in 10 % of patients with an autosomal dominant pattern of transmission [8].

As a role these lesions are solitary and slow-growing, with malignancy difficult to be histologically established and usually based on the presence of metastatic disease [9].

The most common symptoms found are hearing loss , tinnitus, ear pain, dizziness, ear discharge, and bleeding [1].

The expanding and destructive behavior of these benign tumors may present a life-threatening condition depending on the region involved. A combination on therapeutic modalities is needed for an adequate treatment.

Preoperative angiography helps to elucidate tumor origin, its vascular supply and extension. Optimal therapeutic option for paragangliomas usually consists of preoperative embolization and in some cases combined with pre or postoperative radiotherapy.

Characteristically they are highly vascularized lesions with main vascular supply from the ascendant pharyngeal artery. The occipital artery has also been linked as the second most common feeder artery (Fig. 8.1).

Hekster (1973) reported the first embolization of glomus tumor. Since then the indication of preoperative embolization has raised in order to minimize the surgical morbidity [10].

The primary goal of preoperative embolization of glomus tumors is to decrease the tumor volume to a certain extent and to reduce the operative blood loss. Around 80–90 % of tumor blood flow reduction has been reported in the literature, but there is no standard of measurement for technical evaluation of embolization and only qualitatively access to the blood reduction can be experienced by the surgeon.

Murphy and Brackmann reviewed 35 cases of glomus jugulare tumors. Eighteen patients had been submitted to preoperative embolization. A reduction in blood loss and surgical time was observed, but no significant reduction in postoperative neurological deficits [11].

However, some complications have been reported in literature. Cranial nerve palsy after onyx embolization was reported by Gaynor et al., in two cases from a series of 11 patients [5]. Lower particles usage can explain this occurrence, since they reach the small vasculature of vasa vasorum. Even with lack of good evidence to indicate preoperative embolization in glomus tumors it has been a current practice in the treatment of these patients. New prospective studies with an adequate tool of measurement should be developed in the future. Our strategy is to embolize medium- and large-sized jugular foramen paragangliomas with onyx® or gelfoam® 3 days before surgery (Figs. 8.2 and 8.3). According to our experience preoperative embolization reduces the intraoperative bleeding and surgical time. It is also helpful in cases of recurrent tumors (Fig. 8.4).

Intracranial schwannomas represent approximately 8 % of all primary intracranial tumors [12]. Schwannomas arising from the jugular foramen are very rare and account for only 2.9 % of all intracranial schwannomas [13]. They may be located within the jugular foramen or may extend intracranially and/or extracranially.