Jugular Foramen Tumors

"The advent of stereotactic radiosurgery in recent decades provides a more precise technique for administering high-dose focal radiation, and preliminary reports indicate that this modality may have a role in the treatment of jugular foramen tumors."

Harry R. van Loveren

"Jugular foramen tumors are uncommon lesions, dominated by benign tumors (paragangliomas, schwannomas, neurofibromas, and meningiomas). In spite of their benign histopathology, these lesions are characterized by locally destructive behaviour. Presentation is often insidious and the diagnosis delayed. Radiotherapy is inappropriate for the treatment of these radioresistant lesions in generally otherwise healthy patients. Surgical excision by the lateral otologic approaches in established skull base surgical units permits complete resection of these lesions with minimal morbidity and maximum tumor control."

Ugo Fisch

"This idea of 'expectant waiting' was first proposed to me by a skilled head and neck surgeon whose task it has been to fix defects in pharyngolaryngeal function resulting from surgically induced neuropathies. Although some of us may call this option heretical, I think it makes a lot of sense."

Peter G. Smith

The jugular foramen is the most complex foramen of the skull base. It both contains, and is surrounded by, important neurovascular structures. It is in a deep location, and surgical access poses difficulty for both otolaryngologists and neurosurgeons alike. Despite these anatomic challenges, impressive progress has been made in the surgical management of tumors of the jugular foramen. Advances in neuroradiology, the creation of formal skull base teams, and the utilization of microsurgical techniques have all contributed to a lowered surgical morbidity.

This chapter provides an overview of the relevant skull base anatomy needed to understand approaches to the jugular foramen. Because glomus jugulare tumors are, by far, the most common tumor of the jugular foramen, the bulk of the text is devoted to glomus tumors and their management. Although an overview of the surgical classification and treatment algorithm for jugular foramen tumors is provided, we have specifically described our surgical approach to these tumors.

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