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Neuroradiology Apr 2023This study tested the utility of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE-MRI) in differentiating paragangliomas and metastases in the...
PURPOSE
This study tested the utility of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE-MRI) in differentiating paragangliomas and metastases in the jugular foramen in combination with conventional imaging.
METHODS
Forty-nine consecutive patients with paragangliomas or metastases between January 2015 and April 2022 were included in this retrospective study. All patients had pretreatment DWI and DCE-MRI. Between paragangliomas and metastases, normalized apparent diffusion coefficient (nADCmean) and DCE-MRI parameters were compared along with conventional imaging features (enhancement pattern, presence of flow voids, cystic/necrotic change, and bone erosion). The diagnostic performance was tested using receiver operating characteristic (ROC) analysis.
RESULTS
Thirty-five paragangliomas (5 male; median 49 years) and 14 metastases (9 male; median 61 years) were analyzed. The most common 3 primary cancers included 4 lung cancers, 3 breast cancers, and 3 melanomas. The presence of flow void was significantly different between paragangliomas and metastases (21/35 vs 2/14; P = 0.0047) in conventional imaging features, while fractional plasma volume (Vp) was significantly different between the two tumor types (median 0.46 vs 0.19; P < 0.001) in DWI and DCE-MRI parameters. The areas under the ROC curves (AUCs) of the presence of flow void and Vp were 0.72 and 0.93, respectively. The AUC of the combination of the presence of flow void and Vp was 0.95 and significantly improved compared to that of the presence of flow void (P < 0.001).
CONCLUSION
Adding DCE-MRI to the head and neck protocol can aid in the precise differentiation between jugular foramen paragangliomas and metastases.
Topics: Humans; Male; Retrospective Studies; Jugular Foramina; Sensitivity and Specificity; Contrast Media; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging; Breast Neoplasms; Paraganglioma
PubMed: 36635515
DOI: 10.1007/s00234-023-03113-0 -
Acta Neurochirurgica Jan 2023Surgical treatment of dumbbell jugular foramen schwannomas can be challenging. The main goals of surgery are maximal resection with preservation of function and overall...
BACKGROUND
Surgical treatment of dumbbell jugular foramen schwannomas can be challenging. The main goals of surgery are maximal resection with preservation of function and overall patient quality of life.
METHODS
In this paper, we present a step-by-step technical description of a microsurgical resection of dumbbell-shaped JF schwannoma using a modified retrosigmoid infra-jugular approach.
CONCLUSION
The modified retrosigmoid infra-jugular is a safe and suitable approach in selected cases. This technique, however, must be limited only to those tumors with minimal extension into the jugular foramen.
Topics: Humans; Jugular Foramina; Quality of Life; Neurosurgical Procedures; Microsurgery; Neurilemmoma
PubMed: 36469136
DOI: 10.1007/s00701-022-05444-y -
Neurosurgery Apr 2001Our goals were to study the normal histological features of the jugular foramen, compare them with the histopathological features of glomus tumors involving the temporal...
OBJECTIVE
Our goals were to study the normal histological features of the jugular foramen, compare them with the histopathological features of glomus tumors involving the temporal bone, and thus provide insight into the surgical management of these tumors with respect to cranial nerve function.
METHODS
Ten jugular foramen blocks were obtained from five human cadavers after removal of the brain. Microscopic studies of these blocks were performed, with particular attention to fibrous or bony compartmentalization of the jugular foramen, the relationships of the caudal cranial nerves to the jugular bulb/jugular vein and internal carotid artery, and the fascicular structures of the nerves. In addition, we studied the histopathological features of 11 glomus tumors involving the temporal bone (10 patients), with respect to nerve invasion, associated fibrosis, and carotid artery adventitial invasion.
RESULTS
A dural septum separating the IXth cranial nerve from the fascicles of Cranial Nerves X and XI, at the intracranial opening, was noted. Only two specimens, however, had a septum (one bony and one fibrous) producing internal compartmentalization of the jugular foramen. The cranial nerves remained fasciculated within the foramen, with the vagus nerve containing multiple fascicles and the glossopharyngeal and accessory nerves containing one and two fascicles, respectively. All of these nerve fascicles lay medial to the superior jugular bulb, with the IXth cranial nerve located anteriorly and the XIth cranial nerve posteriorly. All nerve fascicles had separate connective tissue sheaths. A dense connective tissue sheath was always present between the IXth cranial nerve and the internal carotid artery, at the level of the carotid canal. The inferior petrosal sinus was present between the IXth and Xth cranial nerves, as single or multiple venous channels. The glomus tumors infiltrated between the cranial nerve fascicles and inside the perineurium. They also produced reactive fibrosis. In one patient, in whom the internal carotid artery was also excised, the tumor invaded the adventitia.
CONCLUSION
Within the jugular foramen, the cranial nerves lie anteromedial to the jugular bulb and maintain a multifascicular histoarchitecture (particularly the Xth cranial nerve). Glomus tumors of the temporal bone can invade the cranial nerve fascicles, and infiltration of these nerves can occur despite normal function. In these situations, total resection may not be possible without sacrifice of these nerves.
Topics: Adult; Aged; Cranial Nerve Injuries; Cranial Nerves; Female; Glomus Jugulare Tumor; Humans; Intraoperative Complications; Male; Microsurgery; Middle Aged; Neoplasm Invasiveness; Reference Values; Skull Base; Skull Neoplasms; Stereotaxic Techniques; Temporal Bone
PubMed: 11322444
DOI: 10.1097/00006123-200104000-00029 -
The Laryngoscope Aug 2005To describe the presentation, radiographic findings, and surgical management of seven patients who have been diagnosed and treated with jugular foramen schwannomas at...
OBJECTIVES/HYPOTHESIS
To describe the presentation, radiographic findings, and surgical management of seven patients who have been diagnosed and treated with jugular foramen schwannomas at the University of Utah.
STUDY DESIGN
Retrospective chart review.
METHODS
The charts of seven patients diagnosed with jugular foramen schwannomas were reviewed for presentation symptoms, radiographic findings, and physical examination findings. For the six who underwent surgical excision, the surgical procedure used, cranial nerve function results, audiometric results, perioperative complications, and other follow-up data are presented.
RESULTS
Seven patients were identified from ages 24 to 69 years. Six of the seven underwent surgical excision. Primary presentation symptoms included dizziness, hearing loss, dysphagia, diplopia, tongue paresis, and hoarseness. The choice of surgical approach was based on the size and location of the tumor. All patients had complete excision of their tumors. The nerve of origin included the glossopharyngeal, vagus, and spinal accessory nerves. Preoperative cranial nerve dysfunction continued postoperatively for lower cranial nerves but resolved in patients who were noted to have preoperative dysfunction of cranial nerve V and VI. The rate of new lower cranial nerve injury was 15% and was only seen in the cranial nerves that were determined to be the nerve of origin. In two cases, a temporary feeding tube was required. No recurrences have been noted to date.
CONCLUSIONS
Jugular foramen schwannomas can be successfully diagnosed preoperatively with computed tomography and magnetic resonance imaging. These tumors can be successfully managed with surgery and low morbidity.
Topics: Adult; Aged; Cranial Nerve Neoplasms; Female; Glomus Jugulare; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Neurilemmoma; Neurosurgical Procedures; Prognosis; Recovery of Function; Retrospective Studies; Risk Assessment; Sampling Studies; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 16094130
DOI: 10.1097/01.mlg.0000172196.76865.a1 -
Acta Neurochirurgica May 2023The anterolateral (juxtacondylar) approach with limited mastoidectomy is a suitable option to expose the postero-inferior part of the jugular foramen (JF). It is...
BACKGROUND
The anterolateral (juxtacondylar) approach with limited mastoidectomy is a suitable option to expose the postero-inferior part of the jugular foramen (JF). It is particularly indicated for tumors extending in the neck beyond the jugular foramen, especially in those cases necessitating both neck control as well as control of the mastoid segment of facial nerve.
METHOD
We describe here the steps to safely perform an anterolateral approach with mastoidectomy along with a brief description of its indications and limits.
CONCLUSION
This approach represents a valid option to reach the JF. Its knowledge can improve the process of optimal approach selection when dealing with complex pathology involving the JF.
Topics: Humans; Meningioma; Jugular Foramina; Mastoidectomy; Neurosurgical Procedures; Head and Neck Neoplasms; Meningeal Neoplasms
PubMed: 36609565
DOI: 10.1007/s00701-022-05482-6 -
World Neurosurgery Dec 2014Tumors of the jugular foramen are notably rare, and the majority of them arise from the glomic tissue of the jugular vein. There are other tumors that do not originate...
OBJECTIVE
Tumors of the jugular foramen are notably rare, and the majority of them arise from the glomic tissue of the jugular vein. There are other tumors that do not originate from that tissue, and these are called the nonglomic tumors. This report includes a series of patients with nonglomic tumors of the jugular foramen to analyze their biological and radiological behavior and the clinical outcomes of patients.
METHODS
Patients with tumors of the jugular foramen other than chemodectomas were included for the present series. All of the patients were subjected to a protocol that included imaging studies and a complete clinical evaluation. Surgery was planned and performed by a multidisciplinary team using the following approaches: retrosigmoid, infratemporal fossa, and zygomatic-transmandibular. Depending on the precise diagnosis and surgical outcomes, radiotherapy or radiosurgery were indicated. The average follow-up period was 5 years.
RESULTS
Thirty patients with nonglomic tumors were included: 18 schwannomas, 6 meningiomas, 5 chordomas, and 1 metastatic carcinoma. The patients with chordomas had the most severe clinical manifestations, and the chordomas were the largest and most invasive tumors that destroyed the jugular foramen contour on imaging studies. Schwannomas presented a more benign clinical evolution and enlarged (but did not destroy) the jugular foramen contour. Two patients died (chordomas) during the follow-up because of tumor activity.
CONCLUSIONS
The most common nonglomic tumor of the jugular foramen was the schwannoma, which was the lesion with the best surgical prognosis. Chordoma is a rare and highly destructive tumor that has a notably high recurrence index.
Topics: Adult; Aged; Combined Modality Therapy; Cross-Sectional Studies; Diagnosis, Differential; Female; Follow-Up Studies; Glomus Jugulare Tumor; Humans; Male; Middle Aged; Neurosurgical Procedures; Prognosis; Retrospective Studies; Skull Base Neoplasms; Treatment Outcome; Young Adult
PubMed: 25045790
DOI: 10.1016/j.wneu.2014.07.013 -
Neurosurgery Jan 2013Jugular foramen schwannomas are uncommon and surgically challenging lesions.
BACKGROUND
Jugular foramen schwannomas are uncommon and surgically challenging lesions.
OBJECTIVE
To determine the importance of surgical technique on morbidity and recurrence of jugular foramen schwannomas.
METHODS
A retrospective review and case-control analysis of a single-senior-surgeon series of 81 patients with surgically treated jugular foramen schwannomas was performed, focusing on operative technique. Patients undergoing an aggressive, total tumor resection (series 1) were compared with those undergoing more conservative resection focusing on preserving the pars nervosa (series 2).
RESULTS
There was a statistically significant (P = .04) decrease in permanent deficits of the cranial nerve 9/10 complex with a conservative technique. Recurrence was seen in 3 patients (5.7%) in series 1 and in 3 patients (10.7%) in series 2 (P = .36). Recurrence was treated with reoperation in 1 patient, radiation in 1 patient, and observation in the others.
CONCLUSION
Although radical gross total resection is desirable, it is not optimal for cranial nerve preservation in patients with jugular foramen schwannomas. A more conservative approach resulted in a statistically significant decrease in lower cranial nerve deficits. There was a nonstatistically significant trend toward increasing recurrence, which may be treated with multiple modality therapy in the modern era.
Topics: Adolescent; Adult; Aged; Case-Control Studies; Cerebrospinal Fluid Leak; Cerebrospinal Fluid Rhinorrhea; Child; Cohort Studies; Cranial Nerve Neoplasms; Female; Follow-Up Studies; Hearing Loss; Humans; Male; Microsurgery; Middle Aged; Neurilemmoma; Neurosurgical Procedures; Reoperation; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 23096422
DOI: 10.1227/NEU.0b013e3182770e74 -
Operative Neurosurgery (Hagerstown, Md.) Aug 2023
Topics: Humans; Jugular Foramina; Head and Neck Neoplasms; Magnetic Resonance Imaging; Neurilemmoma
PubMed: 37133276
DOI: 10.1227/ons.0000000000000732 -
World Neurosurgery Sep 2021Hemangiopericytomas (HPCs) and solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin. Here, the authors present a rare case of anaplastic HPC in the...
BACKGROUND
Hemangiopericytomas (HPCs) and solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin. Here, the authors present a rare case of anaplastic HPC in the jugular foramen (JF). The authors also conduct a systematic review of the literature to examine the current fund of knowledge on JF HPC/SFTs.
METHODS
A systematic MEDLINE search was conducted using key words "hemangiopericytoma" OR "solitary fibrous tumor" AND "jugular foramen" OR "extracranial" OR "skull base." Clinicopathologic characteristics and outcomes of the present case were reviewed and compared with those in the literature.
RESULTS
A 41-year-old male, who had undergone stereotactic radiation therapy 6 years ago for a presumed glomus jugulare tumor, presented to our institution with worsening dysphagia, hoarseness, persistent tongue weakness, and radiographic evidence of tumor progression. The patient underwent uncomplicated gross total resection with sacrifice of the infiltrated hypoglossal nerve. Histopathologic evaluation revealed anaplastic HPC/SFT (World Health Organization grade III). Review of the literature yielded 9 additional cases of JF HPC/SFT in 5 males (56%) and 4 females (44%), with a mean age of 49.6 years old. Patients commonly presented with pain (37.5%) and lower cranial nerve deficits (100%). Preoperative diagnoses included glomus jugulare (n = 2) or JF schwannomas (n = 3). All patients underwent microsurgical resection of the lesion, except for 1 who refused all treatment after diagnostic biopsy.
CONCLUSION
The authors present the only reported case of anaplastic HPC of the JF. The illustrative case and those found on systematic review of the literature highlight the importance of tissue diagnosis and appropriate management.
Topics: Adult; Diagnostic Errors; Glomus Jugulare; Hemangiopericytoma; Humans; Jugular Foramina; Magnetic Resonance Imaging; Male; Radiosurgery
PubMed: 34182175
DOI: 10.1016/j.wneu.2021.06.094 -
Journal of Neurological Surgery. Part... Oct 2019The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to...
The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.
PubMed: 31534895
DOI: 10.1055/s-0038-1676512