Intradural jugular foramen tumors

Abstract

-Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.KEY WORDS: jugular foramen, posterior fossa tumor, lower cranial nerves, skull base reconstruction, glomus tumor. Tumores intradurais do forame jugularRESUMO -Onze pacientes com lesões expansivas do forame jugular associadas ou não a componente extradural foram submetidos a ressecção cirúrgica no Hospital das Clínicas da Universidade Estadual de Campinas (UNI-CAMP) entre 1998 e 2001. Foi utilizada cirurgia combinada com dissecção do pescoço, mastoidectomia sem transposição do nervo facial e técnica de reconstrução miofascial da base do crânio desenvolvida por um dos autores. Quatro pacientes foram operados via craniectomia retrosigmoidea. Ressecção total foi feita em 9 pacientes, subtotal em um e parcial em outro. Nenhum dos 11 pacientes teve progressão da doença em 2 anos de acompanhamento. Não houve mortalidade. Cinco pacientes tiveram déficits adicionais de nervos cranianos baixos. Nove pacientes mantiveram ou melhoraram suas pontuações de acordo com a escala de Karnofsky. Para adequada abordagem do paciente com tumor de forame jugular, são necessários bom conhecimento anatômico da região, exposição cirúrgica ampla, e técnica de reconstrução eficiente para obter cura com baixas taxas de complicações pós-operatórias. PALAVRAS-CHAVE: forame jugular, tumor de fossa posterior, nervos cranianos baixos, reconstrução de base de crânio, tumor de glomus jugular.Jugular foramen (JF) lesions are rare, being paragagliomas and schwannomas the most common tumors 1, 2 . Complete resection of these benign lesions is the treatment of choice. The surgical management of JF lesions remains difficult because their deep location, locally aggressive behavior, involvement of vessels and nerves, infiltration of skull base bone and structures of the high cervical region and the complex anatomy of the region. In the last decades, development of new skull base approaches allowed total resection of large number of skull base tumors. However, the more aggressive the surgical approach becomes, more complications related to it may occur. Reconstru...

Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

“…The tumor origin, size and site may be responsible for delayed presentation 1,6 . The early symptoms of tumors originated in the jugular foramen are, in most cases, conductive hearing loss and tinnitus.…”

“…The early symptoms of tumors originated in the jugular foramen are, in most cases, conductive hearing loss and tinnitus. Other lesions may cause paralysis of the lower cranial pairs as a first symptom 4 1,2,5,8 . It is believed that the diagnosis and nerve origin can be determined by the initial symptoms and the grade of dysfunction of the nerve, especially when compared with adjacent nerves.…”

“…The tumor extension to the cavernous sinus, clivus or brain stem is sometime a limiting factor to the total removal of the lesion. Multidisciplinary approach is sometime needed where neurosurgeons, otorhinolaryngologists and sometimes neuroradiologists work together for a better diagnostic and pre-operative assessment, in addition to a better management of these patients 1,3,4 . Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates.…”

“…The jugular foramen tumors are very rare, and the paragangliomas are the most common tumors of this region 1 . Schwannomas with origin in the jugular foramen are extremely rare, and there are about two hundred cases described in the literature.…”

An Unusual Anatomic Variation of the Jugular Foramen with Doubled Posterior Condylar Canal

“…Different pathologic conditions involve the JF and may result in lower CN deficits (Ramina et al, 2005). Lower cranial nerve deficits leading to dysphagia, breathing difficulty, hoarseness, and pneumonia due to aspiration are potential dangerous problems (Mattos et al, 2004). Understanding the relationship of the compartments of the JF to the lower CN is essential if neural preservation is desired.…”