Skip to main content
SpringerLink
Log in

Jugular Foramen Tumors: Diagnosis and Management

  • Chapter
  • First Online:
Samii's Essentials in Neurosurgery

Abstract

Jugular foramen (JF) tumors are rare skull base lesions, mostly benign, deeply located, and very often hypervascular, and present diagnostic and management difficulties. A large number of different lesions are found or may develop in the JF. The anatomy of the JF region is complex containing important neurovascular and bony structures. Several anatomical studies have been performed but the surgical anatomy of this region remains poorly understood. These tumors, once thought to be one of the most difficult skull base tumor to remove, are now managed with reasonable morbidity and mortality rates. Aim of treatment is radical removal to obtain cure of benign lesions with preservation of cranial nerves and vessels. This goal remains, however, a challenge in spite of all developments in skull base surgery and interventional neuroradiology, due to tumor location, involving important anatomical structures and infiltration of skull base bone. Precise knowledge of the anatomy of JF and related regions (temporal bone, posterior fossa, and high cervical region) is necessary to approach these lesions. The main surgical difficulties with these tumors are related to deep location, hypervascularization, and involvement of cranial nerves (VII, VII, IX, X, and XI) and vessels like the internal carotid artery (ICA) and the vertebral artery (VA) and its branches. The multidisciplinary management of these tumors by neurosurgeons, ENT surgeons, and interventional neuroradiologist led to a better understanding of diagnosis, preoperative evaluation, and treatment of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alford BR, Guilford FR (1962) A comprehensive study of tumors of the glomus jugulare. Laryngoscope 72:765–805

    Article  CAS  PubMed  Google Scholar 

  2. Al-Mefty O, Teixeira A (2002) Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 97:1356–1366

    Article  PubMed  Google Scholar 

  3. Anand V (1989) Reconstruction in cranial base surgery: surgery of the cranial base. Kluwer Academic Publishers, Boston, pp 297–314

    Google Scholar 

  4. Ariyan S (1990) Pectoralis major muscle and musculocutaneous flaps. In: Strauch B, Vasconez LO, Hall-Findlay EJ (eds) Grabb’s encyclopedia of flaps. Little Brown, Boston, pp 512–522

    Google Scholar 

  5. Bikhazi PH, Roeder E, Attaie A et al (1999) Familial paragangliomas: the emerging impact of molecular genetics on evaluation and management. Am J Otol 20:639–643

    CAS  PubMed  Google Scholar 

  6. Bowdino B, Farrell P, Moore G et al (2004) Long-term surgical results for glomus temporale tumors. Neurosurg Q 14:19–26

    Article  Google Scholar 

  7. Brackmann DE, House WF, Terry R, Scanlan RL (1972) Glomus jugulare tumors: effect of irradiation. Trans Am Acad Ophthalmol Otolaryngol 76:1423–1431

    CAS  PubMed  Google Scholar 

  8. Brown JS (1985) Glomus jugulare tumors revisited: a ten-year statistical follow-up of 231 cases. Laryngoscope 95:284–288

    Article  CAS  PubMed  Google Scholar 

  9. Carvalho GA, Tatagiba M, Samii M (2000) Cystic schwannomas of the jugular foramen: clinical and surgical remarks. Neurosurgery 46:560–566

    Article  CAS  PubMed  Google Scholar 

  10. Chang DW, Langstein HN, Gupta A et al (2001) Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 107:1346–1357

    Article  CAS  PubMed  Google Scholar 

  11. Chen TC, Maceri DR, Levy ML et al (1994) Brain stem compression secondary to adipose graft prolapse after translabyrinthine craniotomy: case report. Neurosurgery 35:521–524

    Article  CAS  PubMed  Google Scholar 

  12. Colen TY, Mihm FG, Mason TP, Roberson JB (2009) Catecholamine-secreting paragangliomas: recent progress in diagnosis and perioperative management. Skull Base 19(6):377–385

    Article  PubMed Central  PubMed  Google Scholar 

  13. Cummings BJ, Beale FA, Garrett PG, Harwood AR, Keane TJ, Payne DG, Rider WD (1984) The treatment of glomus tumors in the temporal bone by mega voltage radiation. Cancer 53:2635–2640

    Article  CAS  PubMed  Google Scholar 

  14. Fayad JN, Keles B, Brackmann DE (2010) Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol 31(2):299–305

    Article  PubMed  Google Scholar 

  15. Fisch U (1982) Infratemporal fossa approach for glomus tumors of the temporal bone. Ann Otol Rhinol Laryngol 91:474–479

    CAS  PubMed  Google Scholar 

  16. Gal TJ, Kerschner JE, Futran ND et al (1998) Reconstruction after temporal bone resection. Laryngoscope 108:476–481

    Article  CAS  PubMed  Google Scholar 

  17. Gartrell BC, Hansen MR, Gantz BJ, Gluth MB, Mowry SE, Aagaard-Kienitz BL, Baskaya MK, Gubbels SP (2012) Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol. Otol Neurotol 33(7):1270–1275

    Article  PubMed Central  PubMed  Google Scholar 

  18. Glasscock ME, Harris PF, Newsome G (1974) Glomus tumors: diagnosis and treatment. Laryngoscope 84:2006–2032

    Article  PubMed  Google Scholar 

  19. Green JD, Brackmannn DE, Nguyen CD, Arriaga MA, Telischi FF, De la Cruz A (1994) Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 104:917–921

    PubMed  Google Scholar 

  20. Guild SR (1941) A Hitherto Unrecognized Structure: The Glomus Jugularis in Man. Abstracted. Anat Rec 79(Suppl 2):28

    Google Scholar 

  21. Gulya AJ (1993) The glomus tumor and its biology. Laryngoscope 103(Suppl 60):7–15

    CAS  PubMed  Google Scholar 

  22. Hwang PH, Jackler RK (1996) Lipoid meningitis due to aseptic necrosis of a free fat graft placed during neurotologic surgery. Laryngoscope 106:1482–1486

    Article  CAS  PubMed  Google Scholar 

  23. Jackson CG, Glasscock ME, Nissen AJ, Schwaber MK (1982) Glomus tumor surgery: the approach, results and problems. Otolaryngol Clin North Am 15(4):897–916

    CAS  PubMed  Google Scholar 

  24. Jackson CG, Woods CI, Chironis PN (1993) Glomus jugulare tumors. In: Sekhar LN, Janecka IP (eds) Surgery of cranial base tumors. Raven Press, New York, pp 747–768

    Google Scholar 

  25. Jones NF, Schramnn VL, Sekhar LN (1987) Reconstruction of the cranial base following tumour resection. Br J Plast Surg 40:155

    Article  CAS  PubMed  Google Scholar 

  26. Katsuta T, Rhoton AL Jr, Matsushima T (1997) The jugular foramen: microsurgical anatomy and operative approaches. Neurosurgery 41:149–202

    Article  CAS  PubMed  Google Scholar 

  27. Kempe LG (1982) Glomus jugulare tumor. In: Youmans JR (ed) Neurological surgery. WB Sunders Co, Philadelphia, pp 3285–3298

    Google Scholar 

  28. Kim JA, Elkon D, Lim ML, Constable WC (1980) Optimum dose of radiotherapy for chemodectomas of the middle ear. Int J Radiol Oncol Biol Phys 6:815–819

    Article  CAS  Google Scholar 

  29. Konefal JB, Pilepich MV, Spector GJ, Perez CA (1987) Radiation therapy in the treatment of chemodectomas. Laryngoscope 97:1331–1335

    Article  CAS  PubMed  Google Scholar 

  30. Lalwani AK, Jackler RK, Gutin PH (1993) Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor. Am J Otol 14:398–402

    CAS  PubMed  Google Scholar 

  31. Lang J (1989) Anatomy of the jugular foramen. In: Samii M, Draf W (eds) Surgery of the skull base. Springer, Berlin, pp 59–64

    Google Scholar 

  32. LarnerJM HSS, Spaulding CA, Constable WC (1992) Glomus jugulare tumors: long-term control by radiation therapy. Cancer 69:1813–1817

    Article  Google Scholar 

  33. Lattes R, Waltner JG (1949) Nonchromaffin paraganglioma of the middle ear. Cancer 2(3):447–468

    Article  CAS  PubMed  Google Scholar 

  34. Makiese O, Chibbaro S, Marsella M, Tran Ba Huy P, George B (2012) Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases. Neurosurg Rev 35(2):185–194

    Article  PubMed  Google Scholar 

  35. Mattos JP, Ramina R, Borges W, Ghizoni E, Fernandes YB, Paschoal JR, Honorato DC, Borges G (2004) Intradural jugular foramen tumors. Arq Neuropsiquiatr 62(4):997–1003

    Article  PubMed  Google Scholar 

  36. Molony TB, Brackmann DE, Lo WW (1992) Meningiomas of the jugular foramen. Otolaryngol Head Neck Surg 106:128–136

    CAS  PubMed  Google Scholar 

  37. Murphy TP, Brackmann DE (1989) Effects of preoperative embolization on glomus jugular tumors. Laryngoscope 99:1244–1247

    Article  CAS  PubMed  Google Scholar 

  38. Neligan PC, Mulholland S, Irish J et al (1996) Flap selection in cranial base reconstruction. Plast Reconstr Surg 98:1159–1168

    Article  CAS  PubMed  Google Scholar 

  39. Netterville JL, Civantos EJ (1993) Defect reconstruction following neurologic skull base surgery. Laryngoscope 103:55–63

    CAS  PubMed  Google Scholar 

  40. Oestreicher-Kedem Y, Agrawal S, Jackler RK, Damrose EJ (2010) Surgical rehabilitation of voice and swallowing after jugular foramen surgery. Ann Otol Rhinol Laryngol 119(3):192–198

    PubMed  Google Scholar 

  41. Peker S, Sengöz M, Kılıç T, Pamir MN (2012) Gamma knife radiosurgery for jugular foramen schwannomas. Neurosurg Rev 35(4):549–553. doi:10.1007/s10143-012-0380-7; discussion 553

    Article  PubMed  Google Scholar 

  42. Ramina R, Maniglia JJ, Barrionuevo CE (1988) Glomus jugulare tumors: classification and treatment. Presented at the international symposium on cranial base surgery, Pittsburgh, 13–17 Sept

    Google Scholar 

  43. Ramina R, Maniglia JJ, Barrionuevo CE (1993) Chapter 19. Surgical excision of petrous apex lesions. In: Sekhar LN, Janecka IP (eds) Surgery of cranial base tumors. Raven Press, New York

    Google Scholar 

  44. Ramina R, Maniglia JJ, Pedrozo AA, Clemente RS, Meneses MS (1996) Surgical treatment of jugular foramen tumors. Zentralblattfür Neurochirurgie [in German] 57(Suppl):47–48

    Google Scholar 

  45. Ramina R, Maniglia JJ, Fernandes YB, Paschoal JR, Pfeilsticker LN, Coelho Neto M (2004) Jugular foramen tumors: diagnosis and treatment. Neurosurg Focus 17(2):E5

    Article  PubMed  Google Scholar 

  46. Ramina R, Maniglia JJ, Paschoal JR, Fernandes YB, Neto MC, Honorato DC (2005) Reconstruction of the cranial base in surgery for jugular foramen tumors. Neurosurgery 56(2 Suppl):337–343; discussion 337–343

    Article  PubMed  Google Scholar 

  47. Ramina R, Maniglia JJ, Fernandes YB, Paschoal JR, Pfeilsticker LN, Coelho NM (2005) Tumors of the jugular foramen: diagnosis and management. Neurosurgery 57(1 Suppl):59–68

    Article  PubMed  Google Scholar 

  48. Ramina E, Neto MC, Fernandes YB, Aguiar PH, de Meneses MS, Torres LFB (2006) Meningiomas of the jugular foramen. Neurosurg Rev 29(1):55–60

    Article  PubMed  Google Scholar 

  49. Rhoton AL Jr. (2000) Jugular foramen. Neurosurgery 47(3 Suppl):S267–S285

    Google Scholar 

  50. Ricaurte JC, Murali R, Mandell W (2000) Uncomplicated postoperative lipoid meningitis secondary to autologous fat graft necrosis. Clin Infect Dis 30:613–615

    Article  CAS  PubMed  Google Scholar 

  51. Roberstson JT, Clark WC, Robertson JH, Gardner LG (1990) Glomus jugulare tumors: neurological surgery, 3rd edn. WB Saunders Company, Philadelphia, pp 3654–3666

    Google Scholar 

  52. Rosenwasser H (1945) Carotid body like tumor involving the middle ear and mastoid bone. Arch Otolaryng 41:64–67

    Article  Google Scholar 

  53. Rosenwasser H (1952) Glomus jugulare tumors. Laryngoscope 62:623–633

    Article  CAS  PubMed  Google Scholar 

  54. Rosenwasser H (1968) Glomus jugulare tumors. I. Historical background. Arch Otolaryngol 88(1):3–5

    Article  Google Scholar 

  55. Samii M, Tatagiba M (1996) Tumors of the jugular foramen. Neurosurg Q 6(3):176–193

    Article  Google Scholar 

  56. Sedney CL, Nonaka Y, Bulsara KR, Fukushima T (2013) Microsurgical management of jugular foramen schwannomas. Neurosurgery 72(1):42–46

    Article  PubMed  Google Scholar 

  57. Sen C, Hague K, Kacchara R, Jenkins A, Das S, Catalano P (2001) Jugular foramen: microscopic anatomic features and implications for neural preservation with reference to glomus tumors involving the temporal bone. Neurosurgery 48(4):838–848

    CAS  PubMed  Google Scholar 

  58. Shapiro AS, Scully T (1992) Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery 30:241–245

    Article  CAS  PubMed  Google Scholar 

  59. Sharma MS, Gupta A, Kale SS, Agrawal D, Mahapatra AK, Sharma BS (2008) Gamma knife radiosurgery for glomus jugulare tumors: therapeutic advantages of minimalism in the skull base. Neurol India 56(1):57–61

    Article  PubMed  Google Scholar 

  60. Snow RB, Kuhel W, Martin SB (1991) Prolonged lumbar spinal drainage after the resection of tumors of the skull base: a cautionary note. Neurosurgery 28:880–882

    Article  CAS  PubMed  Google Scholar 

  61. Spector GJ, Ciralsky R, Maisel RH et al (1975) IV. Multiple glomus tumors in the head and neck. Laryngoscope 85:1066–1075

    Article  CAS  PubMed  Google Scholar 

  62. Springate SC, Weichselbaum RR (1990) Radiation or surgery for chemodectoma of the temporal bone: a review of local control and complications. Head Neck 12:303–307

    Article  CAS  PubMed  Google Scholar 

  63. Suárez C, Rodrigo JP, Bödeker CC, Llorente JL, Silver CE, Jansen JC, Takes RP, Strojan P, Pellitteri PK, Rinaldo A, Mendenhall WM, Ferlito A (2012) Jugular and vagal paragangliomas: systematic study of management with surgery and radiotherapy. Head Neck. doi:10.1002/hed.22976

    Google Scholar 

  64. Sutiono AB, Kawase T, Tabuse M, Kitamura Y, Arifin MZ, Horiguchi T, Yoshida K (2011) Importance of preserved periosteum around jugular foramen neurinomas for functional outcome of lower cranial nerves: anatomic and clinical studies. Neurosurgery 69(2 Suppl Operative):230–240

    Google Scholar 

  65. Tran Ba Huy P, Kania R, Duet M, Dessard-Diana B, Mazeron J-J, Benhamed R (2009) Evolving concepts in the management of jugular paraganglioma: a comparison of radiotherapy and surgery in 88 cases. Skull Base 19:83–91

    Article  Google Scholar 

  66. vanBaars F, van den Broek P, Cremers C et al (1981) Familial nonchromaffinic paragangliomas (glomus tumors): clinical aspects. Laryngoscope 91:988–996

    CAS  Google Scholar 

  67. van der Mey AG, Maaswinkel-Mooy PD, Cornelisse CJ et al (1989) Genomic imprinting in hereditary glomus tumors: evidence of a new genetic theory. Lancet 2:1291–1294

    PubMed  Google Scholar 

  68. Watkins LD, Mendoza N, Cheesman AD et al (1994) Glomus jugulare tumours: a review of 61 cases. Acta Neurochir 130:66–70

    Article  CAS  PubMed  Google Scholar 

  69. Zak FG (1954) An expanded concept of tumors of glomic tissue. N Y State J Med 54:1153–1165

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurosurgical Department, Neurological Institute of Curitiba, R. Jeremias Maciel Perretto, 300, Curitiba, 80210–310, Brazil

    Ricardo Ramina MD, PhD, Joao Jarney Maniglia MD, PhD & Maurício Coelho Neto MD

  2. Neurosurgical Department, University of Campinas, Campinas, Brazil

    Yvens Barbosa Fernandes MD, PhD & Jorge Rizzato Paschoal MD, PhD

Authors
  1. Ricardo Ramina MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joao Jarney Maniglia MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yvens Barbosa Fernandes MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maurício Coelho Neto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jorge Rizzato Paschoal MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricardo Ramina MD, PhD .

Editor information

Editors and Affiliations

  1. Neurosurgical Department, Neurological Institute of Curitiba (INC), Curitiba, Brazil

    Ricardo Ramina

  2. Neurosurgical Department, Santa Paula Hospital, São Paulo, Brazil

    Paulo Henrique Pires de Aguiar

  3. Dept. of Neurosurgery, Eberhard-Karls University Hospital, Tübingen, Baden-Württemberg, Germany

    Marcos Tatagiba

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Ramina, R., Maniglia, J.J., Fernandes, Y.B., Neto, M.C., Paschoal, J.R. (2014). Jugular Foramen Tumors: Diagnosis and Management. In: Ramina, R., de Aguiar, P., Tatagiba, M. (eds) Samii's Essentials in Neurosurgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54115-5_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54115-5_28

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54114-8

  • Online ISBN: 978-3-642-54115-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation