Differentiating imaging findings in primary and secondary tumors of the jugular foramen

Abstract

The preoperative diagnosis of a jugular foramen tumor may be challenging, since a large variety of unusual lesions may be located in this region. These tumors may be classified as primary lesions (which are located in the jugular foramen or extend from the jugular foramen into the surrounding structures) and as secondary lesions (that extend from the surrounding structures into the jugular foramen). Primary tumors include glomus jugulare tumors, schwannomas, meningiomas and peripheral primitive neuroectodermal tumors, while secondary tumors comprise chordomas, chondrosarcomas, chondroblastomas, giant-cell tumors, cholesterol granulomas, giant cholesterol cyst, endolymphatic sac tumors, reactive myofibroblastic tumors, temporal bone carcinomas and metastases. Accurate preoperative radiological suspicion is of great value for preoperative patient counseling and has a direct impact on the surgical planning in these cases. The present study describes and discusses the main differentiating imaging features of lesions involving the jugular foramen, whose accurate preoperative radiological evaluation is essential for proper surgical planning.

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

“…Type C lesions are primarily extra-cranial with minimal extension for cranial bone or posterior cavity. Pellet et al added the socalled type D, which regards the hour-glassshaped tumor that involves the jugular foramen, with intracranial and extra-cranial components 3,[5][6][7] . These patients are in Type D. The schwannomas are usually solid, circumscribed and well-delimited, and may cause cystic degeneration or primary cysts.…”

“…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.…”

“…On CT scan there may be enlargement of the jugular foramen with well defined osseous margins. The scan without contrast describes hypo or isodense tumor with a reduced capturing of contrast, features which differ it from meningiomas, that present an important contrast capturing, as well as sclerosis and erosion of the subjacent bone 6 . On MRI images there is hyperintensity in T2 and hypointensity in T1, with a strong enhancement after gadolinium administration.…”

“…On MRI images there is hyperintensity in T2 and hypointensity in T1, with a strong enhancement after gadolinium administration. It may present as a heterogeneous tumor due to presence of necrosis or cystic formations 6,8,22 . Cerebral digital subtraction angiography shows moderate vascularization that differ the schwannomas from the paragangliomas of such region, which are intensely vascularized 5 .…”

Jugular Foramen Syndrome as Initial Presentation of Metastatic Lung Cancer

“…Common primary sources include lung, breast, and skin malignancies, and less frequently gastrointestinal, renal, prostate, testicular, and ovarian cancers. 1,2,[4][5][6] In up to 15% of patients, the primary site of malignancy is not known. 1 Some neoplasms, such as melanoma, small-cell lung cancer, and choriocarcinoma, exhibit a unique "neurotropism," or propensity to spread to the CNS.…”