Meningioma of the jugular foramen: glomus jugulare mimic and surgical challenge.
OBJECTIVE
Meningiomas involving the jugular foramen are rare lesions, with approximately 34 cases reported in the English literature. Clinically, these tumors mimic the more common glomus jugulare tumor. After surgical resection, meningiomas have worse cranial nerve outcomes and higher recurrence rates than glomus tumors. There is controversy regarding the selection of surgical approach, particularly with regard to management of the facial nerve. A reliable means of accurate preoperative diagnosis would help surgical planning and patient counseling.


METHODS
We present a series of six consecutive large jugular foramen meningiomas resected by a single surgeon from 1996 to 2002.


METHODS
Retrospective case series (chart review).


RESULTS
The preoperative diagnosis was correct in nearly all (6/7) cases on the basis of the characteristic imaging findings seen with a combination of temporal bone dedicated computed tomography and high-resolution enhanced magnetic resonance imaging. Five of six patients had lateral facial nerve rerouting (infratemporal fossa Fisch type A), and three patients also had posterior rerouting (transcochlear approach with division of greater superficial petrosal nerve). Total tumor removal was accomplished in 83%. One patient suffered recurrence over a mean follow-up period of 2.5 years. New postoperative vocal cord palsies occurred in 50% of patients, and all required vocal cord medialization. At 1 year, 50% of patients had normal or near normal (House-Brackmann I or II) facial function. Postoperative cerebrospinal fluid leaks occurred in two patients, and both eventually required ventriculoperitoneal shunts.


CONCLUSIONS
Meningiomas involving the jugular foramen are surgically challenging tumors that pose unique diagnostic issues. The majority of these lesions can be completely resected. A relatively high postoperative complication rate, which can be controlled with appropriate intervention, is seen with these surgeries.
Gilbert
M Erik
ME
Division of Otolaryngology-Head and Neck Surgery, University of Utah Health Sciences Center, Salt Lake City 84123, USA.
Shelton
Clough
C
McDonald
Andre
A
Salzman
Karen L
KL
Harnsberger
H Ric
HR
Sharma
Pramod K
PK
Jensen
Randy L
RL
D003389:Cranial Nerve Diseases / Q000453:epidemiology; D003937:Diagnosis, Differential; D005154:Facial Nerve / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005924:Glomus Jugulare; D005925:Glomus Jugulare Tumor / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018365:Neoplasm, Residual; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014827:Vocal Cords / Q000601:surgery