Jugular foramen tumors are uncommon lesions, dominated by benign tumors (paragangliomas, schwannomas, neurofibromas, and meningiomas). In spite of their benign histopathology, these lesions are chararcterized 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.


Fisch et al.—CHAPTER 83

1. DiChiro G, Fisher RL, Nelson KB. The jugular foramen. J Neurosurg 1964;21:447-460

2. Guild SR. Glomus jugulare, a nonchromaffin Paraganglion in man. Ann OtolRhinolLaryngol 1953;62:1015-1021

3. Arenberg IK, McCreary HS. Neurilemmomma of the jugular foramen. Laryngoscope 1971;81:544-557

4. Kaye AH, Hahn, JF, Kinney, SE, et al. Jugular foramen schwannomas. J Neurosurg 1984;60:1045-1053

5. Svien HJ, Baker HL, Rivers MH. Jugular foramen syndrome and allied syndromes. Neurology 1963;13:797-809

6. Pluchino G, Crivelli G, Vaghi MA. Intracranial neurinomas of the nerves of the jugular foramen. Report of 12 personal cases. Acta Neurochir 1975;31:201-221

7. Spector GJ, Maisel RH, Ogura JH. Glomus tumors in the middle ear. I. An analysis of 46 patients. Laryngoscope 1973;83:1652-1672

8. Kuhweide R, Lanser MJ, Fisch U. Catecholamine-secreting pargangliomas at the skull base. Skull Base Surg 1996;6:35-45

9. Alford BR, Guilford, FR. A comprehensive study of tumors of the glomus jugulare. Laryngoscope 1962;1:765-787

10. van Baars F, Cremers C, Van Den Broek P, et al. Genetic aspects of nonchromaffin paragangliomas. Hum Genet 1982; 60:305-309

11. Grufferman S, Gillman MW, Pasternak LR, et al. Familial carotid body tumors (case report and epidemiologic review). Cancer 1980;46:2116-2122

12. van der Mey AGL, Maaswinkel-Mooy PD, Cornelisse CJ, et al. Genomic imprinting in hereditary glomus tumors: evidence for new genetic theory. Lancet 1989;2:1291-1294

13. Bickerstaff ER, Howell JS. The neurological importance of tumors of the glomus jugulare. Brain 1953;76:576-593

14. Steinberg N, Holz WG. Glomus jugularis tumors. Arch Otolaryngol 1965;82:387-394

15. Gulya AJ. The glomus tumor and its biology. Laryngoscope 1993;103:7-15

16. House WF, Glasscock ME. Glomus tympanicum tumors. Arch Otolaryngol 1968;87:124-128

17. Glasscock ME, Jackson CG, Dickins JRE, Wiet RJ. Panel discussion: glomus jugulare tumors of the temporal bone. The surgical management of glomus tumors. Laryngoscope 1979; 89:1640-1654

18. Lack EE, Cubilla AL, Woodruff JM, Farr HW. Paragangliomas of the head and neck region. Cancer 1977;39:397-409

19. Glenner GG, Grimley PM. Tumors of the extra-adrenal paraganglion system (including chemoreceptors). In: Harlan I, Firminger MD, eds. Atlas of Tumor Pathology. Washington, DC: Armed Forces Institute of Pathology; 1973

20. Oldring D, Fisch U. Glomus tumors of the temporal region: surgical therapy. Am J Otol 1979;1:7-18

21. Fisch U. Infratemporal fossa approach for glomus tumors of the temporal bone. Ann Otol Rhinol Laryngol 1982;91:474-479

22. Fisch U, Fagan PA, Valavanis A. The infratemporal fossa approach for the lateral skull base. Otolaryngol Clin North Am 1984;17:513-552

23. Fisch U, Mattox D. Microsurgery of the Skull Base. NewYork: Georg Thieme Verlag; 1988:136-353

24. Briner HR, Linder TE, Pauw BP, Fisch U. Long-term results of surgery for temporal bone paraganglioma. Laryngoscope 1999;109:577-583

25. Lustig LR, Jackler RK. The variable relation between the lower cranial nerves and jugular foramen tumors: implications for neural preservation. Am J Otol 1996;17:658-668

26. Woods CI, Strasnick B, Jackson CG. Surgery for glomus tumors: the otology group experience. Laryngoscope 1993;103:65-70

27. Makek M, Franklin DJ, Zhao J, Fisch U. Neural infiltration of glomus temporale tumors. Am J Otol 1990;11:1-5

28. Nelson MD, Kendal BE. Intracranial catecholamine secreting paragangliomas. Neuroradiology 1987;29:277-282

29. Jackson CG. Neurotologic surgery for skull base tumors: diagnosis for treatment planning and treatment options. Laryngoscope 1993;103:17-27

30. Lo WWM, Solti-Bohman LG, Lambert PR. High-resolution CT in the evaluation of glomus tumors of the temporal bone. Radiology 1984;150:737-742

31. Andrews JC, Valavanis A, Fisch U. Management of the internal carotid artery. Laryngoscope 1989;99:1224-1229

32. Palaskas CW, Fisch U, Valavanis A, Pfaltz M. Permanent preoperative carotid artery occlusion and carotid body tumor surgery. Skull Base Surg 1993;3:22-31

33. Schmid S, Moe KS, Fisch U. The internal carotid artery in skull base surgery. In: Gates GA, ed. Current Therapy in

Otolaryngology, Head and Neck Surgery. St Louis; MO: Mosby; 1994:111-115

34. Fisch U. Infratemporal fossa approach for lesions in the temporal bone and base of the skull. Adv Otorhinolaryngol 1984;34:254-266

35. Gjuric M, Seidinger L, Wigand ME. Long-term results of surgery for temporal bone paraganglioma. Skull Base Surg 1996;6:147-152

36. Jackson CG, Haynes DS, Walker PA, et al. Hearing conservation surgery for glomus jugulare tumors. Am J Otol 1996;17:425-437

37. Boyle JO, Shimm DS, Coulthard SW. Radiotherapy for paragangliomas of the temporal bone. Laryngoscope 1990;100:896-901

38. Hawthorne MR, Makek MS, Harris JP, Fisch U. The histo-pathological and clinical features of irradiated and nonirra-diated temporal paragangliomas. Laryngoscope 1988;98: 325-331

39. Lalwani AK, Jackler RK, Gutin PH. Lethal fibrosarcoma complicating radiation therapy for benign glomus jugulare tumor. Am J Otol 1993;14:398-402

40. Brackmann DE, House WF, Terry R, et al. Glomus jugulare tumors: effects of irradiation. Trans Am Acad Ophthamol Otolaryngol 1972;76:1423-1431

41. Spector GJ, Fierstein J, Ogura JH. A comparison of therapeutic modalities of glomus tumors in the temporal bone. Laryngoscope 1976;86:690-696

42. Sharma PD, Johnson AP, Whitton AC. Radiotherapy for jugu-lotympanic paragangliomas (glomus jugulare tumors). J Laryngol Otol 1984;98:621-629

43. Gibbin KP, Henk, JM. Glomus jugulare tumors in South Wales. A twenty year review. Clin Radiol 1978;29:607-609

44. Spector GJ, Compagno J, Perez CA, et al. Glomus jugulare tumors: effects of radiotherapy. Cancer 1975;35:1316-1321

45. Tan LC, Bordi L, Symons L, Cheesman AD. Jugular foramen neuromas. Surg Neurol 1990;34:205-211

46. Horn KL, Hankinson H. Tumors of the jugular foramen. In: Brcakmann DE, ed. Neurotology. St Louis, MO: CV Mosby; 1994:1059-1068

47. Roland P, Glasscock M.E III, Bojrab DI. Neuromas of the skull base. Otolaryngol Head Neck Surg 1986;94:539-547

48. Crumley RL, Wilson C. Schwannomas of the jugular foramen. Laryngoscope 1984;94:772-778

49. Franklin DJ, Moore GF, Fisch U. Jugular foramen peripheral nerve sheath tumors. Laryngoscope 1989;99:1081-1087

50. Gibson FB, Nichols, ML, Weiss RL, Calhoun KH. Pathologic quiz case 2. Plexiform neurofibroma. Arch Otolaryngol Head Neck Surg 1992;118:772-773, 775

51. Kinney SE, Dohn DF, Hahn JF, et al. Neuromas of the jugular foramen. In: Brackmann DE, ed. Neurological Surgery of the Ear and Skull Base. New York: Raven Press; 1982:361-367

52. Horn KL, House WF, Hitselberger WE. Schwannomas of the jugular foramen. Laryngoscope 1985;95:761-765

53. May JS, Fisch U. Neoplasms of the ear and lateral skull base. In: Bailey BJ, ed. Head and Neck Surgery—Otolaryngology. Philadelphia: JB Lippincott; 1993:1575-1576

54. Linder TE, Garvis WJ, Huwyler M, Fisch U. Pediatric-ado-lescent otologic skull base surgery. In: de Souza C, Stankiewicz JA, Pellitteri PK, eds. CA: Textbook of Pediatric Otorhinolaryngology—Head and Neck Surgery. San Diego, CA: Singular Publishing Group; 1998

55. Al-Mefty O. Meningioma. New York: Raven Press; 1991:37-57

56. Gagnon NB, Lavigne F, Mohr G, et al. Extracranial and intracranial meningiomas. J Otolaryngol 1986;15:380-384

57. Kepes JJ. Biology, Pathology and Differential Diagnosis. Philadelphia: Masson USA; 1982

58. Luetje CM, Syms CA, Luxford WE, et al. Meningiomas intrinsic to the geniculate ganglion. Am J Otol 1997;18:393-397

59. Nager GT, Heroy J, Hoeplinger M. Meningiomas invading the temporal bone with extension into the neck. Am J Oto-laryngol 1983;4:297-324

60. Nager GT, Masica DN. Meningioma of the cerebellopontine angle and their relation to the temporal bone. Laryngoscope 1970;80:863-895

61. Austin MB, Mills SE. Neoplasms and neoplasm-like lesions involving the skull base. Ear Nose Throat 1986;65:57-73

62. Barnes L, Kapadia SB. The biology and pathology of selected skull base tumors. J Neurooncol 1994;20:213-240

63. Kennedy JD, Haines SJ. Review of skull base surgery approaches: with special reference to paediatric patients. J Neurooncol 1994;20:291-312

64. Shah MV, Haines, SJ. Paediatric skull, skull base, and meningeal tumors. Neurosurg Clin North Am 1992;3:893-924

65. Hoye JS, Hoar CS, Murray JE. Extrcranial meningioma presenting as a tumor of the neck. Am J Surg 1960;100:486-489

66. Schmidt D, Mackay B, Luna MA, Goepfert H. Aggressive meningioma with jugular vein extension. Arch Otolaryngol 1981;107:635-637

67. Friedman CD, Costantino PD, Teitelbaum B, et al. Primary extracranial meningioma of the head and neck. Laryngoscope 1990;100:41-48

68. Rubinstein LJ. Tumors of the Central Nervous System. Fascicle 6. Washington, DC: Armed Forces Institute of Pathology, 1972

69. Schucknedt HF. Pathology of the Ear. Phiadelphia: Lea & Febiger, 1993:488-489

Jugular Foramen Tumors


Peter G. Smith

The best way to care for a patient who has a jugulotympanic paraganglioma continues to be debated by surgical and radiation oncologists. I believe that the fundamental reasons for the controversy include the overlapping information derived from currently available imaging studies, the protracted clinical course of these histologically benign tumors, the complications associated with a single therapeutic modality, and the clinical bias of the oncologist. In preparing this work, I struggled to resolve my own issues about the subject through a review of the literature. I was left, however, with more questions than answers. What follows, then, is a description of my current approach to helping patients with jugulotympanic paragangliomas. The algorithm reflects my own bias, and I expect it to change with an accumulation of more experience and knowledge derived from controversy.

0 0

Post a comment