Tumors of the Jugular Foramen—Diagnosis and Management

Abstract

Objective: With the advent of modern neurosurgical techniques and multidisciplinary “skull base groups,” surgery has become the treatment of choice for jugular foramen lesions. Tumors with large intracranial extension represent, however, a considerable challenge to the skull base surgeon. With the availability of new diagnostic procedures these tumors have been more precisely studied and questions arise of whether, when, and how these lesions should be treated. Data from 110 consecutive patients, surgically treated in the past 18 years, were retrospectively analyzed to identify surgical outcomes. Methods: Between 1987 and 2006, 110 patients with jugular foramen tumors presenting with intracranial-intradural extension were operated upon at the Neurological Institute of Curitiba and State University of Campinas, Brazil. A multidisciplinary craniocervical approach was the standard method of treatment. The same surgical technique was used to resect all tumors. Preoperative embolization was performed in cases of paragangliomas and well-vascularized meningiomas. Saphenous graft bypass was carried out in 2 patients before removal of the lesions due to infiltration of the ICA. A new muscle-fascia flap was developed by our group and was used to cover the surgical defect. When necessary, the facial nerve was reconstructed with nerve grafts (great auricular nerve) or XII/VII anastomosis. Results: Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. There were 62 paragangliomas, 18 schwannomas, and 11 meningiomas. The most common signs and symptoms were hearing loss and dysfunction of cranial nerves IX, X, and XI. Complete tumor removal was achieved in 89% of benign tumors and 80% of paragangliomas. Lower cranial nerves deficit was the most frequent complication (10 patients, 9.4%); it was transient in 4 cases. Facial and cochlear nerve paralysis occurred in 8 patients (7.5%). The function of facial nerve recovered spontaneously in 3. CSF leak was observed in 4 patients (3.7%). Four patients (3.7%) died after surgery. Conclusion: Radical removal of benign jugular foramen tumors is the treatment of choice and may be curative. Single-stage removal of complex cases of jugular foramen tumors may be performed safely with acceptable morbidity. Postoperative lower cranial nerves deficit is the most serious surgical complication. The possible causes of complications in these large tumors and the strategies used to avoid them will be presented.