Summary

In summary, pathological lesions of the jugular foramen remain a formidable challenge. Surgical resection requires intimate familiarity with the anatomic complexities of this region. Our general preference is for surgical resection of these lesions when possible. Embolization and radiation are also important adjuncts in the management of these diseases. Optimal patient outcomes are best achieved with a multidisciplinary approach to these complicated lesions.

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13. Miller DL, Doppman JL, Chang R. Anatomy of the junction of the inferior petrosal sinus and the internal jugular vein. AJNR 1993;14:1075-1083

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

15. Saleh E, Najuib M, Aristegui M, et al. Lower skull base: anatomic study with surgical implications. Ann Otol Rhinol Laryngol 1995;104:57-61

16. Jackson CG, Cueva RA, Thedinger BA, et al. Cranial nerve preservation in lesions of the jugular fossa. OOtolaryngol Head Neck Surg 1991;105:687-693

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Jugular Foramen Tumors

Ugo Fisch, Thomas Linder, and Phillip Chang

CHAPTER 83

The overwhelming majority of jugular foramen tumors are benign. Only 6% of the tumors are malignant. Paragangliomas, neurogenic tumors, and meningiomas account for more than 80% of lesions of the jugular foramen (Table 83-1). In spite of the benign histologic characteristics of these tumors, all are locally destructive. These tumors are clinically silent until they eventually cause embarrassment of the vital neurovascular structures that traverse, or are in close proximity to, the jugular foramen (Table 83-2). The lower cranial nerves, the facial nerve, and audiologic and vestibular function are all potentially compromised by the slow progression of jugular foramen tumors.

The clinician's ability to detect these lesions has been greatly enhanced with the advent and widespread availability of advanced imaging technology such as computed tomography (CT) and magnetic resonance imaging (MRI). Paragangliomas, schwannomas, and meningiomas are all known to be radioresistant. Surgery is the treatment of choice and provides the only chance of cure. With the current lateral otologic approaches of the skull base (Fig. 83-1), tumor control is excellent. Surgical

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