Jugular Foramen Meningiomas Research Articles

From a High School Student to an Otolaryngologist—19 Years With a Jugular Foramen Meningioma

In this essay, an otolaryngologist reflects on the circular journey from patient to physician to patient again over 19 years living with a left jugular foramen meningioma.

Resection of Skull Base Meningioma With Extensive Extracranial Extension: 2-Dimensional Operative Video.

Jugular foramen meningiomas are rare tumors with distinguishing clinical, radiological, and surgical considerations.1,2 They involve the lower cranial nerves, invade the temporal bone, occlude jugular vein and sigmoid sinus, and involve internal carotid and vertebral arteries. Their location is prime for an extensive extracranial cervical extension. They might reach giant size with extension from the Meckel cave in the cerebellopontine angle to the carotid bifurcation in the neck while exhibiting only minor symptoms. Surgical morbidity is associated mainly with lower cranial nerves deficits. Radical surgical removal has been considered impossible with vascular encasement and is associated with a considerable risk of vascular injury. With careful and thorough preoperative evaluation, including evaluating the adequacy of the cerebral collateral and applying an appropriately tailored skull base approach,3 radical tumor resection can be achieved with the expectation of a good outcome.3,4 Meticulous microsurgical dissection of the tumor involving the internal carotid artery in the neck would permit radical resection without vascular damage and avoiding the need for vascular reconstruction.5 We demonstrate this technique in a 47-year-old female patient presented in the year 2007 having a giant jugular fossa tumor with extensive neck extension who consented to surgery. Image at 2:23 reused with permission from Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg. 2002;97(6):1356-1366, by permission from JNSPG. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_vf9v0duk"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}

Inflammatory Pseudotumor Simulating a Jugular Foramen Meningioma: Case Report, Technical Video, and Literature Review

Inflammatory pseudotumor (IP) is a nonneoplastic, reactive inflammatory process, of unknown etiology, characterized by a proliferation of connective tissue with an inflammatory infiltrate, most commonly involving the lungs and orbits. Primary intracranial IP is an extremely rare entity often arising from the meningeal structures of the skull base. We reported an extremely rare case of a primary intracranial IP located in the cerebellopontine angle, mimicking a jugular foramen meningioma. We further illustrated our microsurgical technique through a surgical video and performed a review of the pertinent scientific literature. The patient underwent gross total microsurgical resection of the tumor mass through a left retrosigmoid approach. Intraoperative neuromonitoring of the VII-VIII cranial nerve complex and lower cranial nerve was performed, and thulium laser fibers were used as a tool for tumor debulking. Postoperatively, the patient's neurologic symptoms recovered. Histopathologic studies showed dense infiltrate of T- and B-cell lymphocytes and epithelioid granulomas, compatible with the diagnosis of IP. Postoperatively, magnetic resonance imaging scans showed complete tumor resection. The patient underwent a 3-month oral corticosteroid therapy showing no signs of recurrence at the radiologic follow-up. Primary intracranial IPs are rare pathologic entities that can mimic extraaxial tumors and should be taken into consideration as a potential differential diagnosis. Complete microsurgical resection in combination with other treatments (steroids therapy, radiotherapy) is the most common treatment of choice and is associated with good outcomes and low rates of recurrence.

Function-Preserving Multimodal Treatment for Jugular Foramen Meningiomas.

Objectives Despite being pathologically benign, jugular foramen meningioma (JFM) may be locally aggressive and spread in three compartments. Because of the complex anatomical location, radical removal of JFM usually causes serious morbidity through lower cranial nerve (LCN) deficits. To accomplish long-standing tumor control with good functional outcomes, we report function-preserving multimodal treatment (FMT) for JFM, comprising the combination of intradural tumor removal with the preservation of LCN function and stereotactic radiosurgery (RS) for the residual tumor. Materials This study investigated six JFM patients (five women, one man). Preoperatively, five patients showed no LCN sign. Results All patients underwent function-preserving retrosigmoid intradural tumor removal, and no patient developed new LCN deficit. Three patients underwent RS for the residual tumor at 8 to 12 months after surgery. After RS, all three tumors were controlled. No patients showed tumor recurrence or new LCN deficits in the follow-up period (2 months to 8 years). Conclusion FMT for JFMs can accomplish long-standing tumor control with excellent functional outcomes.

Microsurgical management of primary jugular foramen meningiomas: a series of 22 cases and review of the literature

This study summarized clinical manifestations, surgical management, histological grading, and long-term outcome of jugular foramen meningiomas (JFMs). Retrospective study was performed in 22 consecutive patients with primary JFMs from January 2004 to October 2010, enrolling 10 men and 12 women with average age of 39.4 (14-57years). The most common initial symptom is hearing disorder, followed by lower cranial nerve dysfunctions. The tumor was classified into type I (intracranial) in 1, type II (intracranial) in 15, type IV (intracranial-extracranial) in 6, and none type III (extracranial). Surgical approaches mainly included retrosigmoid in 7, far lateral in 10, and juxtacondylar in 5, with some variations. The gross total resection was achieved in 15 cases and subtotal resection in 7. Fourteen patients (63.6%) developed new or worse neurological deficits immediately after operation, of whom 11 (78.6%) got alleviation. Postoperatively, keeping airway patency and prevention from aspiration pneumonia is very important. Nasotracheal intubation is much more tolerated than orotracheal intubation for postoperative patient management. WHO grade 2 was found in four cases (18.2%) and grade 3 in one. During the average time of follow-up in 83.2months, only one (grade 3) died of tumor regrowth 20months after surgery and radiosurgery. Five of 17 patients of grade 1 developed tumor regrowth. Radiosurgery provides a good tumor control for tumor regrowth in grade 1, or postoperative grade 2 tumor. In conclusion, JFMs has a favorable long-term overall survival; however, neurological preservation is still challenging, especially low cranial nerves.

Surgical treatment of jugular foramen meningiomas

ObjectWe present our experience with surgery of jugular foramen meningiomas with special consideration of clinical presentation, surgical technique, complications, and outcomes. MethodsThis retrospective study includes three patients with jugular foramen meningiomas treated by the senior author between January 2005 and December 2010. The initial symptom for which they sought medical help was decreased hearing. In all of the patients there had been no other neurological symptoms before surgery. The transcondylar approach with sigmoid sinus ligation at jugular bulb was suitable in each case. ResultsNo death occurred in this series. All of the patients deteriorated after surgery mainly due to the new lower cranial nerves palsy occurred. The lower cranial nerve dysfunction had improved considerably at the last follow-up examination but no patient fully recovered. Two of three patients with preoperatively impaired yet functional hearing deteriorated after surgery with no subsequent cranial nerve VIII function improvement. In one case postoperative stereotactic radiosurgery was performed due to non-radical tumour resection (Simpson Grade IV) and tumour remnant proved stable in the 4-year follow-up. None of the patients have shown signs of tumour recurrence in the mean follow-up period of 56 months. ConclusionsJugular foramen meningiomas represent one of the rarest subgroups of meningiomas and their surgical treatment is associated with significant risk of permanent cranial nerve deficits.

Microsurgical Treatment for Primary Jugular Foramen Meningiomas

Background: Jugular foramen meningiomas (JFMs) comprise a rare subtype of intracranial meningiomas, with unique clinical manifestations, neuroimagings, and surgical treatment compared with jugular glomus and schwannoma.

Microsurgical treatment for jugular foramen meningiomas

To explore the microsurgical treatment and clinical efficacies of jugular foramen meningiomas. A total of 28 patients with jugular foramen meningiomas undergoing microsurgical operations at Beijing Tiantan Hospital during the period from April 1996 to April 2011 were analyzed retrospectively. The retrosigmoid suboccipital (n = 13), far lateral (n = 9), postauricular trans-supracondylar (n = 4) and trans-paracondylar approaches (n = 2) were used. Complete tumor resection was achieved in 18 patients and subtotal tumor resection in 10 patients. Twenty-two patients were followed up for a mean follow-up period of 3 years. The postoperative Karnofsky performance scale was above 80 in 19 patients. Twelve patients experienced hoarseness or bucking, 11 lived independently and 2 died of tumor recurrence. Jugular foramen meningiomas have a higher recurrence rate and severe cranial nerve damages may occur postoperatively. It is important to classify them into different clinical entities and choose appropriate surgical approaches and techniques so as to achieve satisfactory outcomes.

Microsurgical treatment for primary jugular foramen meningiomas

Objective To summarize the clinical manifestations,neuroimaging,surgical treatment of jugular foramen meningiomas (JFM). Methods A retrospective study of a total of 22 consecutive patients with primary JFMs treated in Beijing Tiantan hospital from January 2004 to October 2010 was performed.It included 10 male and 12 female,with average age of 39.4 ( 14 ～57 yrs).The most common symptoms was hearing disorder,followed by lower cranial nerve dysfunctions.The types of tumors included Type A (intracranial) in 15 patients,type B (intraforamen) in 1,type D (dumbell) in 6.There was no type C (extracranial).The surgical approaches were selected on tumor growth manners,including pre - sigmoid- bulb approach,retro- sigmoid- bulb,and combined that consist retrosigmoid,midline hockey- stick and postauricular C shaped incision.The surgical approaches were used in postauricular C shaped approach (pre- SBA) in 5 cases,suboccipital retrosigmoid in 7 and submidline hockey -stick in 10.Results The total resection was achieved in 18 cases,subtotal in 4.The pathological examination revealed WHO Ⅱ in 4 cases,WHO Ⅲ in one.The neurological function dropped immediately after surgery in most cases,while recovery was gained.Keeping airway patency and prevention from swallow difficulty were quite important for postoperative management.Only one patient died of tumor regrowth 20 months after the surgery for the highly malignant nature ( WHO Ⅲ ).Conclusions The surgical approaches for primary JFMs could be classified into Pre - SBA,Retro - SBA and combined approach.Non - benign meningioma is quite common at a rate about 20％.The function preservation of low cranial nerves is still challenging. Key words: Jugular foramen; Meningioma; Skull base surgery; Multidisciplinary collaboration

Surgical Management of Jugular Foramen Meningioma

Background and Objective: Jugular foramen meningioma (JFM) presents a challenge for intraoperative protection of neural and vessel structures and for postoperative nursing, which are important outcomes for patients with JFM.

A Case of Jugular Foramen Meningioma Mimicking Paraganglioma (Glomus Jugulare)

Meningioma, which usually occurs in the intracranial fossa, occurs only extremely rarely in temporal bone. Tumors extending to the mesotympani are so similar that differentiating between meningioma and paraganglioma is very difficult. We report a case preoperatively diagnosed as glomus jugulare involving radical dissection, but determined postoperatively to be jugular foramen meningioma. Although the subject’s postoperative condition remains satisfactory, follow up must include collaboration with the neurosurgeon. It cannot be emphasized enough that jugular foramen meningioma must be diagnosed from characteristic radiological findings and differentiated from paraganglioma.

Fine-needle aspiration cytology of jugular foramen meningioma presenting as parapharyngeal mass

Fine-needle aspiration cytology of jugular foramen meningioma presenting as parapharyngeal mass

Jugular Foramen Meningiomas: Review of the Major Surgical Series

Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.

Surgical Management of Jugular Foramen Meningiomas: A Series of 13 Cases and Review of the Literature

Primary meningiomas occurring within the jugular foramen are exceedingly rare lesions presumed to originate from arachnoid-lining cells situated within the jugular foramen. The objective of this study is to analyze the management and outcome in a series of 13 primary jugular foramen meningiomas collected at a single center. Retrospective study. Quaternary referral otology and skull base private center. Charts belonging to 13 consecutive patients with pathologically confirmed jugular foramen meningioma surgically treated between September 1991 and May 2005 were examined retrospectively. The follow-up of the series ranged from 12 to 120 (mean, 42.8 +/- 27.5) months. Four (28.5%) patients underwent single-stage tumor removal through the petro-occipital transigmoid (POTS) approach. In two patients with preoperative unserviceable hearing, a combined POTS-translabyrinthine approach was adopted. Two patients underwent a combined POTS-transotic approach because of massive erosion of the carotid canal. A modified transcochlear approach type D with posterior rerouting of the facial nerve and transection of the sigmoid sinus and jugular bulb was performed in two patients with a huge cerebellopontine angle tumor component with extension to the prepontine cistern together with massive involvement of the petrous bone and middle ear and encasement of the vertical and horizontal segments of the intrapetrous carotid artery. In one patient with evidence of a dominant sinus on the site of the tumor, a subtotal tumor removal via an enlarged translabyrinthine approach (ETLA) was planned to resect the intradural component of the tumor. Two patients in our series underwent a planned staged procedure on account of a huge tumor component in the neck. One of these patients underwent a first-stage infratemporal fossa approach type A to remove the tumor component in the neck; the second-stage intradural removal of the tumor was accomplished via an ETLA. The last patient underwent a first-stage modified transcochlear type D approach to remove the intradural tumor component followed by a second-stage transcervical procedure for removal of the extracranial component. Gross total tumor removal (Simpson grade I-II) was achieved in 11 (84.6%) cases. Subtotal removal of the tumor was accomplished in two patients. Good facial nerve function (grades I and II) was achieved in 46.1% of cases, whereas acceptable function (grade III) was achieved in the remaining cases 1 year after tumor removal. Hearing was preserved at the preoperative level in all four patients who underwent surgery via the POTS approach. After surgery, no patient recovered function of the preoperatively paralyzed lower cranial nerves. A new deficit of one or more of the lower cranial nerves was recorded in 61.5% of cases. Surgical resection is the treatment of choice for jugular foramen meningiomas. Among the various surgical techniques proposed for dealing with these lesions, we prefer the POTS approach alone or combined with the translabyrinthine or transotic approaches. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge.

Meningiomas of the jugular foramen

Primary meningiomas of the jugular foramen are extremely rare. There is controversy regarding the management of these tumors. The objective of this article is to analyze the treatment and results in a series of ten cases. From a series of 107 patients that had been operated on for jugular foramen tumors between 1987 and 2005, ten had meningiomas. The clinical, histological and imaging findings, as well as the outcome of these cases, were reviewed. A high incidence of malignant or aggressive tumors (six cases) was found. Gross total resection (Simpson I and II) was achieved in five patients. Four patients with meningotheliomatous meningiomas are alive, with a mean follow-up time of 71.8 months (6.5 years). Two patients (one with anaplastic type and one with papillary type) died in the immediate postoperative period. Four patients (two with papillary type, one with microcystic type and one with anaplastic type) died because of disease progression, with a mean survival time of 35 months. Radical removal of benign jugular foramen meningiomas is possible. The incidence of postoperative deficit of cranial nerves is higher than in other benign tumors of the jugular foramen. A high incidence of aggressive (malignant) tumors was observed in this series.

Jugular Foramen Meningiomas

Jugular foramen meningiomas are rare lesions. They arise from arachnoid villi associated with the jugular bulb. They can be classified into primary or secondary lesions and they have the tendency to invade lower cranial nerves, posterior fossa, temporal bone, and the parapharyngeal space.

Jugular foramen papillary meningioma: A case report

Jugular foramen meningioma is very rare. Papillary meningioma, the histological aspects and clinical behavior of which are highly malignant, is also very rare. Only 55 cases of jugular foramen meningioma have been reported in the literature. To our knowledge, this is the first report of a jugular foramen papillary meningioma. A 25-year-old woman presented with hoarseness and right hearing disturbance. Neurological examination showed deficits of the right hypoglossal and vagus nerves with palsy. Magnetic resonance imaging (MRI) revealed a mass on the right jugular foramen extending intracranially and extracranially, with weak contrast enhancement. The intracranial tumor was removed via the right lateral suboccipital approach. Histopathological examination confirmed the diagnosis of papillary meningioma. We report here the first case of jugular foramen papillary meningioma. No completely effective treatment for papillary meningiomas exists at present, with the exception of surgery.

Primary Malignant Cerebellopontine Angle Melanoma Presenting as a Presumed Meningioma: Case Report and Review of the Literature

Primary intracranial melanomas are rare, especially in the primary cerebellopontine angle. We describe a patient with a presumed jugular foramen meningioma that was found to be of melanotic origin at surgery. We followed this 26-year-old woman with mild ataxia with serial imaging for 18 months after the initial discovery of a cerebellopontine angle extra-axial mass. She developed worsening symptoms of ataxia, dysphagia, and right-sided hearing loss. Magnetic resonance imaging showed an interval increase in size of the mass. The lesion was thought to be a meningioma with a dural tail that extended into the jugular foramen and hypoglossal canal. She underwent preoperative angiography and attempted tumor embolization, followed by resection via a transcochlear infratemporal approach. At surgery the lesion was found to be heavily pigmented. Pathological analysis was consistent with a low-grade melanoma. No primary extracranial site was identified. One year after surgery the patient remains free of systemic disease or recurrence.

Meningioma of the jugular foramen: glomus jugulare mimic and surgical challenge.

Meningiomas involving the jugular foramen are rare lesions, with approximately 34 cases reported in the English literature. Clinically, these tumors mimic the more common glomus jugulare tumor. After surgical resection, meningiomas have worse cranial nerve outcomes and higher recurrence rates than glomus tumors. There is controversy regarding the selection of surgical approach, particularly with regard to management of the facial nerve. A reliable means of accurate preoperative diagnosis would help surgical planning and patient counseling. We present a series of six consecutive large jugular foramen meningiomas resected by a single surgeon from 1996 to 2002. Retrospective case series (chart review). The preoperative diagnosis was correct in nearly all (6/7) cases on the basis of the characteristic imaging findings seen with a combination of temporal bone dedicated computed tomography and high-resolution enhanced magnetic resonance imaging. Five of six patients had lateral facial nerve rerouting (infratemporal fossa Fisch type A), and three patients also had posterior rerouting (transcochlear approach with division of greater superficial petrosal nerve). Total tumor removal was accomplished in 83%. One patient suffered recurrence over a mean follow-up period of 2.5 years. New postoperative vocal cord palsies occurred in 50% of patients, and all required vocal cord medialization. At 1 year, 50% of patients had normal or near normal (House-Brackmann I or II) facial function. Postoperative cerebrospinal fluid leaks occurred in two patients, and both eventually required ventriculoperitoneal shunts. Meningiomas involving the jugular foramen are surgically challenging tumors that pose unique diagnostic issues. The majority of these lesions can be completely resected. A relatively high postoperative complication rate, which can be controlled with appropriate intervention, is seen with these surgeries.

Jugular foramen meningioma

A case of jugular foramen meningioma is presented with a review of the related literature. The value of computed tomography in the diagnosis of the lesion and in the planning of the operative approach is discussed.