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Neurosurgical Focus Aug 2004Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of... (Review)
Review
OBJECT
Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes.
METHODS
The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004. All patients underwent surgery with a multidisciplinary method combining neurosurgical and ear, nose, and throat techniques. Preoperative embolization was performed for paragangliomas and other highly vascularized lesions. To avoid postoperative cerebrospinal fluid (CSF) leakage and to improve cosmetic results, the surgical defect was reconstructed with specially developed vascularized flaps (temporalis fascia, cervical fascia, sternocleidomastoid muscle, and temporalis muscle). A saphenous graft bypass was used in two patients with tumor infiltrating the internal carotid artery (ICA). Facial nerve reconstruction was performed with grafts of the great auricular nerve or with 12th/seventh cranial nerve anastomosis. Residual malignant and invasive tumors were irradiated after partial removal. The most common tumor was paraganglioma (58 cases), followed by schwannomas (17 cases) and meningiomas (10 cases). Complete excision was possible in 45 patients (77.5%) with paragangliomas and in all patients with schwannomas. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 10 patients (10%), but it was transient in four cases. Postoperative facial and cochlear nerve paralysis occurred in eight patients (8%); spontaneous recovery occurred in three of them. In the remaining five patients the facial nerve was reconstructed using great auricular nerve grafts (three cases), sural nerve graft (one case), and hypoglossal/facial nerve anastomosis (one case). Four patients (4%) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation.
CONCLUSIONS
Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.
Topics: Adult; Aged; Angiography, Digital Subtraction; Chondrosarcoma; Chordoma; Cranial Nerve Injuries; Cranial Nerves; Embolization, Therapeutic; Female; Glomus Jugulare Tumor; Humans; Intraoperative Complications; Male; Mastoid; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Invasiveness; Neurilemmoma; Postoperative Complications; Radiotherapy, Adjuvant; Retrospective Studies; Skull Base; Skull Base Neoplasms; Surgical Flaps; Tinnitus; Tomography, X-Ray Computed
PubMed: 15329020
DOI: 10.3171/foc.2004.17.2.5 -
Operative Neurosurgery (Hagerstown, Md.) Dec 2023This approach is intended for tumors centered in the jugular foramen with extensions between intracranial and extracranial spaces, possible spread to the middle ear, and...
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE
This approach is intended for tumors centered in the jugular foramen with extensions between intracranial and extracranial spaces, possible spread to the middle ear, and variable bony destruction. 1,2.
ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT
Jugular foramen paragangliomas are complex lesions that usually invade and fill related venous structures. They present complex relationships with skull base neurovascular structures as internal carotid artery, lower cranial nerves (CNs), middle ear, and mastoid segment of facial nerve. In this way, it is essential to perform an adequate preoperative vascular study to evaluate sinus patency and the tumor blood supply, besides a computed tomography scan to depict bone erosion.
ESSENTIAL STEPS OF THE PROCEDURE
Mastoidectomy through an infralabyrinthine route up to open the lateral border of jugular foramen, allowing exposure from the sigmoid sinus to internal jugular vein. Skeletonization of facial canal without exposure of facial nerve is performed and opening of facial recess to give access to the middle ear in way of a fallopian bridge technique. 2-10.
PITFALLS/AVOIDANCE OF COMPLICATIONS
If there is preoperative preservation of lower CN function, it is important to not remove the anteromedial wall of the internal jugular vein and jugular bulb. In addition, facial nerve should be exposed just in case of preoperative facial palsy to decompress or reconstruct the nerve.
VARIANTS AND INDICATIONS FOR THEIR USE
Variations are related mainly with temporal bone drilling depending on the extensions of the lesion, its source of blood supply, and preoperative preservation of CN function.Informed consent was obtained from the patient for the procedure and publication of his image.Anatomy images were used with permission from:• Ceccato GHW, Candido DNC, and Borba LAB. Infratemporal fossa approach to the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.• Ceccato GHW, Candido DNC, de Oliveira JG, and Borba LAB. Microsurgical Anatomy of the Jugular Foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.
Topics: Humans; Jugular Foramina; Skull Base; Glomus Jugulare Tumor; Temporal Bone; Cranial Nerves
PubMed: 37350587
DOI: 10.1227/ons.0000000000000775 -
World Neurosurgery May 2022Inflammatory pseudotumor (IP) is a nonneoplastic, reactive inflammatory process, of unknown etiology, characterized by a proliferation of connective tissue with an... (Review)
Review
Inflammatory pseudotumor (IP) is a nonneoplastic, reactive inflammatory process, of unknown etiology, characterized by a proliferation of connective tissue with an inflammatory infiltrate, most commonly involving the lungs and orbits. Primary intracranial IP is an extremely rare entity often arising from the meningeal structures of the skull base. We reported an extremely rare case of a primary intracranial IP located in the cerebellopontine angle, mimicking a jugular foramen meningioma. We further illustrated our microsurgical technique through a surgical video and performed a review of the pertinent scientific literature. The patient underwent gross total microsurgical resection of the tumor mass through a left retrosigmoid approach. Intraoperative neuromonitoring of the VII-VIII cranial nerve complex and lower cranial nerve was performed, and thulium laser fibers were used as a tool for tumor debulking. Postoperatively, the patient's neurologic symptoms recovered. Histopathologic studies showed dense infiltrate of T- and B-cell lymphocytes and epithelioid granulomas, compatible with the diagnosis of IP. Postoperatively, magnetic resonance imaging scans showed complete tumor resection. The patient underwent a 3-month oral corticosteroid therapy showing no signs of recurrence at the radiologic follow-up. Primary intracranial IPs are rare pathologic entities that can mimic extraaxial tumors and should be taken into consideration as a potential differential diagnosis. Complete microsurgical resection in combination with other treatments (steroids therapy, radiotherapy) is the most common treatment of choice and is associated with good outcomes and low rates of recurrence.
Topics: Granuloma, Plasma Cell; Humans; Jugular Foramina; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Skull Base Neoplasms
PubMed: 35092811
DOI: 10.1016/j.wneu.2022.01.069 -
Radiology Case Reports Aug 2022Adenoid cystic carcinoma is a slowly growing malignant tumor with high local recurrence, perineural and vascular invasion. This tumor might arise from the glands of...
Adenoid cystic carcinoma is a slowly growing malignant tumor with high local recurrence, perineural and vascular invasion. This tumor might arise from the glands of upper respiratory tract and oral cavity (eg, salivary or serous or mucous). Here we report the case of a 65-year-old woman who was referred to our unit for left retro-auricular radiating pain with trigger points and frontal headache since 6 months. There was no involvement of cranial nerves. Imaging screening using MRI, Positron emission tomography with 2-[fluorine-18] fluoro-2-deoxy-D-glucose, Gallium-68 DOTA-Phe1-Tyr3-Octreotide (68Ga DOTATOC) Positron emission tomography-CT suggested a suspicion of schwannoma or paraganglioma of the jugular foramen. However, the CT-guided biopsy revealed presence of adenoid cystic carcinoma. These warrants performing mandatory histological analysis combined with imaging screening suspicion of schwannoma or paraganglioma.
PubMed: 35663812
DOI: 10.1016/j.radcr.2022.04.046 -
Skull Base : Official Journal of North... Jan 2009
PubMed: 19568337
DOI: 10.1055/s-0028-1124015 -
Pediatric Neurosurgery 2023Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other... (Review)
Review
INTRODUCTION
Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other pathologies.
CASE PRESENTATION
We report an extremely rare case of a 14-year-old female patient with jugular foramen myxoid chondrosarcoma that was completely removed through microsurgical resection.
CONCLUSION
The primary purpose of the treatment is gross total resection of the chondrosarcomas. However, adjuvant methods such as radiotherapy should additionally be applied in patients who have high-grade diseases or cannot undergo gross total resection because of anatomic localization.
Topics: Female; Humans; Child; Adolescent; Jugular Foramina; Chondrosarcoma; Neoplasms, Connective and Soft Tissue
PubMed: 37231851
DOI: 10.1159/000530990 -
AJR. American Journal of Roentgenology Feb 2004Primary jugular foramen meningiomas behave differently from meningiomas arising elsewhere. The differences have important clinical, imaging, and surgical implications.... (Review)
Review
OBJECTIVE
Primary jugular foramen meningiomas behave differently from meningiomas arising elsewhere. The differences have important clinical, imaging, and surgical implications. We reviewed the imaging appearances of primary jugular foramen meningiomas and evaluated them for features that might assist in differentiating them from other common jugular foramen lesions.
MATERIALS AND METHODS
A retrospective review identified five cases of primary jugular foramen meningioma. We defined it as primary when it was centered in the jugular foramen and secondary when it was centered in the posterior fossa with secondary extension into the jugular foramen. Secondary jugular foramen meningiomas were excluded from this study. Eight cases of jugular foramen paraganglioma and 10 cases of jugular foramen schwannoma were reviewed for comparison.
RESULTS
Primary meningioma was characterized by centrifugal infiltration surrounding the skull base (5/5), a permeative-sclerotic appearance to the bone margins of the jugular foramen (5/5), and prominent dural tails (5/5). Flow voids were absent in all cases. Paraganglioma showed localized skull base infiltration, with predominant superolateral spread into the middle ear cavity (8/8). Flow voids and permeative destruction of the bone margins of the jugular foramen were typical. Schwannoma caused expansion of the jugular foramen with scalloped well-corticate bone margins, without skull base infiltration.
CONCLUSION
Primary jugular foramen meningioma is characterized by extensive skull base infiltration. A centrifugal pattern of spread, a permeative-sclerotic appearance of the bone margins of the jugular foramen, the presence of dural tails, and an absence of flow voids are particularly important features that assist in differentiating primary jugular foramen meningioma other more common jugular foramen lesions.
Topics: Adult; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Occipital Bone; Retrospective Studies; Skull Neoplasms; Temporal Bone; Tomography, X-Ray Computed
PubMed: 14736665
DOI: 10.2214/ajr.182.2.1820373 -
Neurosurgical Focus Aug 2004Schwannomas of the jugular foramen are rare, comprising between 2 and 4% of intracranial schwannomas. The authors retrospectively analyzed their surgical experience with... (Review)
Review
OBJECT
Schwannomas of the jugular foramen are rare, comprising between 2 and 4% of intracranial schwannomas. The authors retrospectively analyzed their surgical experience with schwannomas of the lower cranial nerves that presented with intra- and extracranial extensions through an enlarged jugular foramen. The transcondylar suprajugular approach was used without sacrificing the labyrinth or the integrity of the jugular bulb. In this report the clinical and radiological features are discussed and complications are analyzed.
METHODS
This retrospective study includes six patients (three women and three men, mean age 31.6 years) with dumbbell-shaped jugular foramen schwannomas that were surgically treated by the senior author during a 5.5-year period. One patient had undergone previous surgery elsewhere. Glossopharyngeal and vagal nerve deficits were the most common signs (appearing in all patients), followed by hypoglossal and accessory nerve deficits (66.6%). Two or more signs or symptoms were present in every patient. Three tumors presented with cystic degeneration. In four patients the jugular bulb was not patent on neuroimaging studies. The suprajugular approach was used in five patients; the origin of the tumor from the 10th cranial nerve could be defined in three of them. All lesions were completely resected. No death or additional postoperative cranial nerve deficits occurred in this series. Aspiration pneumonia developed in one patient. Preoperative deficits of the ninth and 10th cranial nerves improved in one third of the patients and half recovered mobility of the tongue. No recurrence was discovered during the mean follow-up period of 32.8 months.
CONCLUSIONS
With careful, extensive preoperative evaluation and appropriate planning of the surgical approach, dumbbell-shaped jugular foramen schwannomas can be radically and safely resected without creating additional neurological deficits. Furthermore, recovery of function in the affected cranial nerves can be expected.
Topics: Accessory Nerve Diseases; Adult; Cranial Nerve Neoplasms; Female; Glossopharyngeal Nerve Diseases; Humans; Magnetic Resonance Imaging; Male; Neurilemmoma; Postoperative Complications; Pregnancy; Pregnancy Complications, Neoplastic; Preoperative Care; Retrospective Studies; Skull Base Neoplasms; Vagus Nerve Diseases
PubMed: 15329024
DOI: 10.3171/foc.2004.17.2.9 -
European Journal of Medical Research Jan 2022Unilateral jugular stenosis is easily mistaken as jugular hypoplasia for their similar jugular appearances. This study aimed to propose a scheme to differentiate...
PURPOSE
Unilateral jugular stenosis is easily mistaken as jugular hypoplasia for their similar jugular appearances. This study aimed to propose a scheme to differentiate acquired internal jugular vein stenosis (IJVS) from congenital jugular variation through two case examples.
METHODS
We presented a dynamic evolution process of the IJVS formation, through a case of a 17-year-old female with paroxysmal nocturnal hemoglobinuria (PNH)-associated right internal jugular venous thrombosis (IJVT), which resulted in post-thrombotic IJVS in the rare context of rapid recanalization. Meanwhile, we compared her images with images of a 39-year-old healthy male with hypoplastic IJV to determine the differences between the acquired IJVS and congenital dysplasia.
RESULTS
Based on the first case, we noticed the whole formative process of acquired IJVS from nothing to something. Meantime, we found that acquired IJVS was surrounded by abnormal corkscrew collaterals as imaged on contrast-enhanced magnetic resonance venography (CE-MRV), and the ipsilateral jugular foramen (JF) was normal-sized as displayed on computer tomography (CT). Conversely, jugular hypoplasia was with ipsilateral stenotic JF and without serpentine collaterals.
CONCLUSION
JF morphology and venous collaterals may be deemed as surrogate identifiers to distinguish acquired unilateral IJVS from jugular hypoplasia.
Topics: Adolescent; Adult; Collateral Circulation; Constriction, Pathologic; Female; Humans; Jugular Foramina; Jugular Veins; Magnetic Resonance Angiography; Male; Phlebography; Thrombosis; Vascular Malformations
PubMed: 35027084
DOI: 10.1186/s40001-022-00636-9 -
Child's Nervous System : ChNS :... Jul 2024To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF)...
OBJECTIVE
To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF) stenosis may determine dural venous sinus alterations and increased venous outflow resistance as main pathophysiological factor.
METHODS
Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls.
RESULTS
Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm vs. 57.5 + 20.7 mm, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019).
CONCLUSION
In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.
Topics: Female; Humans; Infant; Infant, Newborn; Male; Constriction, Pathologic; Hydrocephalus; Jugular Foramina; Magnetic Resonance Angiography; Case-Control Studies
PubMed: 38642112
DOI: 10.1007/s00381-024-06414-8