Surgical Treatment of Jugular Foramen Tumors

  Objective  To evaluate the key surgical points for treatment of jugular foramen tumors.

  Methods  Twelve patients with jugular foramen tumors treated surgically from February 2008 to December 2010 in Peking Union Medical College Hospital were reviewed retrospectively. All patients underwent CT or MRI. Their tumors were removed using microsurgical techniques and they were followed up for 14-45 months.

  Results  Among 12 patients with jugular foramen tumors, 11 underwent complete surgical resection of the tumor, 1 underwent near-total resection of the tumor and postoperatively treated by gamma knife. One-stage facial nerve reconstruction was carried out in 4 cases, including 2 cases of auricular nerve grafting and 2 cases of facial-hypoglossal nerve anastomosis. The pathological results of 12 cases showed that 8 were paraganglioma, 1 hypoglossal nerve sheath tumor, 1 meningioma, 1 chondrosteoma, and 1 middle ear cholesterol granuloma. Five cases achieved improved symptoms postoperatively, 5 cases had no improvement in symptoms, and 2 cases had worsened symptoms with severe dysphagia and hoarseness, mainly for Ⅻ, Ⅹ cranial nerve permanent palsy. One of the cases with worsened symptoms underwent cricopharyngeal myotomy and typeⅠthyroplasty 5 months after operation, and the other underwent esophageal sphincter resection and typeⅠthyroplasty 7 months after operation. Both achieved significantly improved postoperative condition.

  Conclusions  The anatomical environment of the region of jugular foramen tumors is complex, and we should choose the appropriate surgical approach based on patients' different situations and image data for individualized treatment. To completely remove the tumor and retain or reconstruct the major blood vessels and nerve function is the key point for surgical management.