scholarly journals Jugular foramen tumors: diagnosis and treatment

2004 ◽  
Vol 17 (2) ◽  
pp. 31-40 ◽  
Author(s):  
Ricardo Ramina ◽  
Joao Jarney Maniglia ◽  
Yvens Barbosa Fernandes ◽  
Jorge Rizzato Paschoal ◽  
Leopoldo Nizan Pfeilsticker ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Great Auricular Nerve ◽  
Csf Leakage ◽  
Nerve Anastomosis

Object Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes. Methods The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004. All patients underwent surgery with a multidisciplinary method combining neurosurgical and ear, nose, and throat techniques. Preoperative embolization was performed for paragangliomas and other highly vascularized lesions. To avoid postoperative cerebrospinal fluid (CSF) leakage and to improve cosmetic results, the surgical defect was reconstructed with specially developed vascularized flaps (temporalis fascia, cervical fascia, sternocleidomastoid muscle, and temporalis muscle). A saphenous graft bypass was used in two patients with tumor infiltrating the internal carotid artery (ICA). Facial nerve reconstruction was performed with grafts of the great auricular nerve or with 12th/seventh cranial nerve anastomosis. Residual malignant and invasive tumors were irradiated after partial removal. The most common tumor was paraganglioma (58 cases), followed by schwannomas (17 cases) and meningiomas (10 cases). Complete excision was possible in 45 patients (77.5%) with paragangliomas and in all patients with schwannomas. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 10 patients (10%), but it was transient in four cases. Postoperative facial and cochlear nerve paralysis occurred in eight patients (8%); spontaneous recovery occurred in three of them. In the remaining five patients the facial nerve was reconstructed using great auricular nerve grafts (three cases), sural nerve graft (one case), and hypoglossal/facial nerve anastomosis (one case). Four patients (4%) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation. Conclusions Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.

scholarly journals Jugular Foramen Tumors

2011 ◽  
Vol 3 (1) ◽  
pp. 15-23 ◽  
Author(s):  
C Rayappa
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Radical Resection ◽  
Jugular Foramen ◽  
Cranial Base ◽  
Lower Cranial Nerve ◽  
Radiological Features ◽  
Lower Cranial Nerves

ABSTRACT Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. These tumors have characteristic radiological features. Radical resection of these tumors with preservation of the lower cranial nerves is the treatment of choice. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge.

scholarly journals Endoscopic Removal of Skull Base Chordoma Type III through Single Skull Base Approach: Our Early Experience

2019 ◽  
Vol 9 (1) ◽  
pp. 57-63
Author(s):  
Shamsul Alam ◽  
Mohammad Sujan Sharif ◽  
Rathin Haldar ◽  
Anil Chaudhury ◽  
Abdullah Al Mahbub ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Lower Cranial Nerve ◽  
Base Approach ◽  
Type Iii ◽  
Skull Base Approach ◽  
Skull Base Chordoma

Introduction: Skull base chordomas present with headache, commonly VI cranial nerve palsy or sometimes with lower cranial nerve involvement.Sometimes in neglected case it presents with complete blindness and facial nerve palsy. Case presentation: A 60-year old man presented with headache,visual disturbance progressing to blindness and facial nerve palsy. At first, radiological imaging showed large tumor which eroded his clivus, sella floor and involved both cavernous carotid more on left side,both ethmoid sinus,middle cranial fossa entension with transdural extension posteriorly. Conclusion: Patients who present with complete blindness and facial nerve palsy, endoscopic excision in a single skull base approach of a skull base chordoma type III is challenging and who developed visual improvement following surgery, has been highlighted in this report. Bang. J Neurosurgery 2019; 9(1): 57-63

scholarly journals Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

2012 ◽  
Vol 18 (2) ◽  
pp. 183-192
Author(s):  
Forhad H Chowdhury ◽  
Mohammod R Haque ◽  
Mahmudul Hasan
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Young Male ◽  
Carotid Bifurcation ◽  
Short Review ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Cervical Approach ◽  
High Cervical

Introduction: Jugular foramen tumor is a rare tumor. Jugular foramen schwannoma is rarer. This type of tumor may present in combination of different cranial nerve palsies in the form of different syndromes or may also be diagnosed incidentally. Management of such tumor is not straight forward.Case reports: Two young male presented with headache, vomiting, gait instability, right sided hearing loss. Clinically they had different cranial nerves dysfunction. Imaging showed jugular foramen tumor extending from posterior fossa to almost common carotid bifurcation at neck in both cases. Near total microsurgical excisions of the tumor were done through retrosigmoid suboccipital plus transmastoid high cervical approach with facial nerve mobilization in one case and without mobilization in other case. In case 1 combination of lower cranial nerve palsies is unique with inclusion of VIII nerve and that does not belong to any of the jugular foramen syndromes (i.e. Vernet, Collet- Sicard, Villaret, Tapia, Schmidt, and Jackson). Here IX, X, XI, XII and VIII cranial palsies was present (i.e.Collet-Sicard syndrome plus VIII nerve syndrome!). In the second case there was IX & X dysfunction with VIII dysfunction. We also went through the short review of the literature here DOI: http://dx.doi.org/10.3329/bjo.v18i2.12015 Bangladesh J Otorhinolaryngol 2012; 18(2): 183-192

Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx

2014 ◽  
Vol 120 (2) ◽  
pp. 377-381 ◽  
Author(s):  
Brandon G. Gaynor ◽  
Mohamed Samy Elhammady ◽  
Daniel Jethanamest ◽  
Simon I. Angeli ◽  
Mohammad A. Aziz-Sultan
Keyword(s):  
Cranial Nerve ◽  
Transarterial Embolization ◽  
Cranial Nerves ◽  
Cranial Neuropathy ◽  
Preoperative Embolization ◽  
Facial Nerve Paralysis ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Glomus Jugulare ◽  
Cranial Nerve Dysfunction

Object The resection of glomus jugulare tumors can be challenging because of their inherent vascularity. Preoperative embolization has been advocated as a means of reducing operative times, blood loss, and surgical complications. However, the incidence of cranial neuropathy associated with the embolization of these tumors has not been established. The authors of this study describe their experience with cranial neuropathy following transarterial embolization of glomus jugulare tumors using ethylene vinyl alcohol (Onyx, eV3 Inc.). Methods The authors retrospectively reviewed all cases of glomus jugulare tumors that had been treated with preoperative embolization using Onyx at their institution in the period from 2006 to 2012. Patient demographics, clinical presentation, grade and amount of Onyx used, degree of angiographic devascularization, and procedural complications were recorded. Results Over a 6-year period, 11 patients with glomus jugulare tumors underwent preoperative embolization with Onyx. All embolization procedures were completed in one session. The overall mean percent of tumor devascularization was 90.7%. No evidence of nontarget embolization was seen on postembolization angiograms. There were 2 cases (18%) of permanent cranial neuropathy attributed to the embolization procedures (facial nerve paralysis and lower cranial nerve dysfunction). Conclusions Embolizing glomus jugulare tumors with Onyx can produce a dramatic reduction in tumor vascularity. However, the intimate anatomical relationship and overlapping blood supply between these tumors and cranial nerves may contribute to a high incidence of cranial neuropathy following Onyx embolization.

INCIDENCE OF CRANIAL NERVE PARALYSIS IN POLIOMYELITIS IN RELATION TO PRESENCE OR ABSENCE OF TONSILS

PEDIATRICS ◽  
1958 ◽  
Vol 21 (1) ◽  
pp. 106-111
Author(s):  
F. H. Top
Keyword(s):  
Facial Nerve ◽  
Rural Area ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Nerve Paralysis ◽  
Cranial Nerve Paralysis ◽  
Clinical Type ◽  
Composite Study

A study of patients from a largely rural area in Iowa corroborates the evidence of many previous studies that bulbar and bulbospinal types of poliomyelitis occur more commonly in persons whose tonsils have been removed irrespective of the time in life the operation was performed. The tonsillectomy rate for all cases was the lowest encountered thus far. Agreement is not on the same level as noted in the author's Detroit composite study previously reported, and is more marked for bulbospinal than for the bulbar type of poliomyelitis (some studies combine bulbar and bulbospinal cases). Adjustment for age reduces differences between cases with tonsils absent and tonsils present by clinical type and further strengthens the finding of Paffenbarger and of the author's Detroit composite study that age must be reckoned with in an assessment of the problem. Incidence of paralyses of cranial nerves by tonsillectomy status is similar to the Detroit composite study in the case of palatal and pharyngeal paralyses but less strongly; incidence of paralysis of the facial nerve is dissimilar.

Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study

2007 ◽  
Vol 116 (7) ◽  
pp. 542-549 ◽  
Author(s):  
Sertac Yetiser ◽  
Ugur Karapinar
Keyword(s):  
Facial Nerve ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cranial Nerves ◽  
Facial Nerve Paralysis ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Reliable Technique ◽  
Nerve Paralysis ◽  
Nerve Anastomosis

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.

scholarly journals Late Pseudo-Exacerbation of Myasthenia Gravis Due to Ectopic Thymoma Invading Lower Cranial Nerves

1990 ◽  
Vol 17 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Gregg MacLean ◽  
Alan Guberman ◽  
Antonio Giulivi
Keyword(s):  
Myasthenia Gravis ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Cervical Mass ◽  
Ectopic Thymoma ◽  
Cranial Nerve Palsies ◽  
Lower Cranial Nerves ◽  
Repeated Aspiration

ABSTRACT:Dysarthria, dysphagia and repeated aspiration in a 54-year-old woman diagnosed and treated for myasthenia gravis 7 years earlier were initially thought to represent a late exacerbation of myasthenia. A cervical mass invading the jugular foramen and causing multiple lower cranial nerve palsies was biopsied and found to represent invasive ectopic thymoma.

scholarly journals Skull base chondrosarcoma radiosurgery: report of the North American Gamma Knife Consortium

2015 ◽  
Vol 123 (5) ◽  
pp. 1268-1275 ◽  
Author(s):  
Hideyuki Kano ◽  
Jason Sheehan ◽  
Penny K. Sneed ◽  
Heyoung L. McBride ◽  
Byron Young ◽  
...  
Keyword(s):  
Overall Survival ◽  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
North American ◽  
Cranial Nerve ◽  
Team Approach ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
The North

OBJECT Stereotactic radiosurgery (SRS) is a potentially important option for patients with skull base chondrosarcomas. The object of this study was to analyze the outcomes of SRS for chondrosarcoma patients who underwent this treatment as a part of multimodality management. METHODS Seven participating centers of the North American Gamma Knife Consortium (NAGKC) identified 46 patients who underwent SRS for skull base chondrosarcomas. Thirty-six patients had previously undergone tumor resections and 5 had been treated with fractionated radiation therapy (RT). The median tumor volume was 8.0 cm3 (range 0.9–28.2 cm3), and the median margin dose was 15 Gy (range 10.5–20 Gy). Kaplan-Meier analysis was used to calculate progression-free and overall survival rates. RESULTS At a median follow-up of 75 months after SRS, 8 patients were dead. The actuarial overall survival after SRS was 89% at 3 years, 86% at 5 years, and 76% at 10 years. Local tumor progression occurred in 10 patients. The rate of progression-free survival (PFS) after SRS was 88% at 3 years, 85% at 5 years, and 70% at 10 years. Prior RT was significantly associated with shorter PFS. Eight patients required salvage resection, and 3 patients (7%) developed adverse radiation effects. Cranial nerve deficits improved in 22 (56%) of the 39 patients who deficits before SRS. Clinical improvement after SRS was noted in patients with abducens nerve paralysis (61%), oculomotor nerve paralysis (50%), lower cranial nerve dysfunction (50%), optic neuropathy (43%), facial neuropathy (38%), trochlear nerve paralysis (33%), trigeminal neuropathy (12%), and hearing loss (10%). CONCLUSIONS Stereotactic radiosurgery for skull base chondrosarcomas is an important adjuvant option for the treatment of these rare tumors, as part of a team approach that includes initial surgical removal of symptomatic larger tumors.

scholarly journals Extended Anterolateral Infralabyrinthine Transjugular Approach for Microsurgical Resection of Giant Glomus Vagale Tumor: Operative Video and Technical Nuances

2020 ◽  
Author(s):  
James K. Liu ◽  
Kevin Zhao ◽  
Soly Baredes ◽  
Robert W. Jyung
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Neck Mass ◽  
Preoperative Embolization ◽  
Rare Type ◽  
Lower Cranial Nerve ◽  
Microsurgical Resection ◽  
The Right ◽  
Lower Cranial Nerves

AbstractGlomus vagale tumor is a paraganglioma of the vagus nerve. It is a rare type of benign tumor that occupies the head and neck and skull base regions. Patients often present with lower cranial nerve dysfunctions such as difficulty swallowing, tongue weakness, and hoarseness. Surgical treatment can be complex and difficult due to its high vascularity, frequent involvement of lower cranial nerves, and surrounding critical vascular structures. In this operative video, we demonstrate an extended anterolateral infralabyrinthine transjugular approach for microsurgical resection of a giant glomus vagale tumor in a 53-year-old male who presented with an enlarging neck mass, difficulty swallowing, right tongue weakness, and hoarseness. Imaging revealed a giant glomus vagale tumor in the right parapharyngeal space extending into the jugular foramen with occlusion of the internal jugular vein. After preoperative embolization, the patient underwent a near-total resection of the tumor with a small microscopic residual at the pars nervosa. In summary, the extended anterolateral infralabyrinthine transjugular approach is a useful strategy for removal of giant glomus vagale tumors extending into the skull base. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/L0EosQK95LE.

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