Jugular Foramen Tumors

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Abstract

The management of jugular foramen (JF) tumors remains a challenge despite the considerable progress over the last decades. Their location deep in a confined space of the skull base and the close proximity or even involvement of vital neural structures and/or major vessels complicates surgical removal. Jugular foramen tumors arise either primary within the foramen—glomus jugulare tumors and schwannomas of the 9th–11th cranial nerves—or from neighboring structures and involve the foramen secondarily: meningiomas, chordomas, chondrosarcomas, cholesteatomas, endolymphatic sac tumor, chondroblastoma, lymphangioma, temporal bone carcinoma, sarcoma, and metastases. Primary bone tumors may also present as JF lesions. Management options of JF tumors include observation, radiation therapy and surgery, or combination of these modalities. The ideal one is complete surgical excision with preservation of all neurological functions, which leads to definitive healing of the patients, provided the tumor is benign. In malignant tumors and in those infiltrating essential structures, subtotal removal with adjuvant radiotherapy may be the most reasonable option. Subtotal tumor removal is preferred also in cases, in which radical surgery carries high risk of new neurologic deficits. Thus, in case of normally functioning preoperatively lower cranial nerves, a tightly adherent tumor part, for example, in the jugular foramen, might be left. Contrary, if a severe lower cranial nerve dysfunction is already present, complete tumor removal should be favored.