SURGERY OF JUGULAR FORAMEN LESIONS - AN INSTITUTIONAL EXPERIENCE

Abstract

Jugular foramen tumors are rare skull base tumors having complex neurovascular anatomy. Most common being paragangliomas, lower cranial nerve schwannomas and meningiomas. Being the conduit for important neuro-vascular structures, potential complications following surgery are a frequent source of morbidity. Retrospective study done from March 2008 to September 2014. All patients underwent highresolution computer tomography (HRCT) of temporal bones and magnetic resonance imaging (MRI) with angiography in pre-operative period. Surgical approach and pre-operative endovascular intervention depended on the site and extent of the lesion. Extent of tumor removal was determined at the time of surgery. Patients with incomplete excisions in postoperative imaging were subjected to radiotherapy depending on histo-pathological diagnosis. Total of 22 patients of jugular foramen lesion were operated. Histopathological diagnosis included paraganglioma(n=18), schwannomas(n=2), p l a s m a c y t o m a ( n = 1 ) , s q u a m o u s c e l l carcinoma(n=1). Eighth cranial nerve was the most common involved nerve preoperatively (100%). Infratemporal Fossa approach, along with its modication, and conservative jugulopetrosectomy approach were used for surgical excision as per the extent of tumor. Complete excision was done in 73% (n=16), and postoperative radiotherapy was given to rest of the patients. The most common postoperative complication was lower cranial nerve decit in immediate post op period(n=15, 68%) (new onset n= 3, 13% and n=12, 55% had preoperative paresis), on follow up lower cranial nerve palsy improved in 50% in follow up (n=7). Most common tumor of the jugular foramen was paraganglioma followed by lower cranial nerve schwannoma. Surgical management depends on the extent of tumor. Multidisciplinary approach provides better patient outcome. Histopathological diagnosis aids to give targeted radiotherapy to the local site, and hence surgical excision of JFT(Jugular foramen tumor) is recommended.