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Non-paraganglioma Jugular Foramen Tumors

Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition

What’s inside

5 sections · 97 slides

  1. 01

    Jugular foramen anatomy and tumor spectrum

    • Location of the jugular foramen
    • Pars nervosa and pars vascularis
    • Jacobson's and Arnold's nerves
    • Relative frequency of jugular foramen tumors
    • Non-paraganglioma tumors covered
    • Lesions excluded from this discussion
    • Clinical presentation of jugular foramen tumors
    • Jugular foramen syndromes
    • Localisation of lower cranial nerve deficits
    • Why both CT and MRI are required
    • Recommended CT protocol
    • Recommended MRI protocol
    • Preoperative assessment of the venous system
    • Treatment options across tumor types

    14 slides

  2. 02

    Jugular foramen schwannoma

    • Epidemiology of jugular foramen schwannoma
    • Neurofibromatosis type 2 in young patients
    • Presenting symptoms of jugular foramen schwannoma
    • Anatomical extent and symptom burden
    • Smooth scalloped enlargement of the jugular foramen
    • CT features of jugular foramen schwannoma
    • MRI signal characteristics of a lower cranial nerve schwannoma
    • MRI features of jugular foramen schwannoma
    • Permeative destructive bone change of jugular paraganglioma
    • Growth pattern along the parent nerve
    • Nerve of origin and direction of spread
    • Kaye and Pellet classification of extent
    • Indications for observation
    • Principles of surgical approach
    • Venous invasion: schwannoma versus paraganglioma
    • Retrosigmoid craniotomy for intracranial tumors
    • Approaches for tumors centred in the foramen
    • Facial nerve rerouting and the fallopian bridge
    • Approaches for predominantly extracranial tumors
    • Neurological complications of resection
    • Cerebrospinal fluid leak and mortality
    • Prevention and management of CSF leak
    • Extent of resection in schwannoma
    • Conservative versus gross total resection
    • Facial nerve outcome after resection
    • Follow-up after schwannoma treatment
    • Recommended imaging surveillance schedule
    • Evidence for stereotactic radiotherapy in schwannoma
    • Patient selection for stereotactic radiation
    • Cranial nerve recovery after radiotherapy
    • Timing of radiotherapy relative to growth
    • Recurrence after schwannoma resection
    • Contrast with vestibular schwannoma recurrence
    • Cranial nerve outcomes in schwannoma

    34 slides

  3. 03

    Jugular foramen meningioma

    • Epidemiology of jugular foramen meningioma
    • Presenting features of jugular foramen meningioma
    • Conductive hearing loss with an intact ossicular chain
    • Hyperostotic bone change adjacent to a jugular foramen meningioma
    • CT features of jugular foramen meningioma
    • Growth pattern of primary jugular foramen meningioma
    • Enhancing mass with dural tails at the jugular foramen
    • MRI features of jugular foramen meningioma
    • Observation of jugular foramen meningioma
    • Surgical approaches to jugular foramen meningioma
    • Advantages of facial nerve rerouting in meningioma
    • Stereotactic radiation for jugular foramen meningioma
    • Timing of adjuvant radiation after subtotal resection
    • Recurrence of jugular foramen meningioma
    • Function-preserving multimodal strategy
    • Cranial nerve outcomes across the three tumor types
    • Facial nerve and radiotherapy outcomes in meningioma

    17 slides

  4. 04

    Metastatic disease of the jugular foramen

    • Frequency of intracranial and temporal bone metastasis
    • Primary sites metastasising to the jugular foramen
    • Presentation of metastatic jugular foramen disease
    • Destructive bone change from metastatic melanoma
    • Renal cell carcinoma metastasis imitating a paraganglioma
    • Imaging features of jugular foramen metastasis
    • Observation and whole brain radiotherapy
    • Surgical excision of metastatic deposits
    • Radiotherapy for metastatic jugular foramen disease
    • Systemic therapy in metastatic disease
    • Cranial nerve outcomes and dose limits

    11 slides

  5. 05

    Differentiating the tumors and key messages

    • Bony change on CT by tumor type
    • MRI features that discriminate
    • Preoperative versus postoperative cranial nerve deficit
    • Role of observation and radiotherapy by tumor type
    • Selecting the surgical approach
    • Key messages
    • Key messages on management
    • References
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    • References (continued)
    • Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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    16 slides