Treatment Strategy in Jugular Foramen Tumors

Objective: A retrospective analysis of the jugular foramen tumors (JFTs) operated on by the author was done in an attempt to define the best course of action.

Materials and Methods: Between 1989 and August 2011, 117 JFTs (49 schwannomas, 36 glomus jugulare, 19 meningiomas, 7 chordomas, 2 endolymphatic sac tumors, 1 granuloma, and 3 metastases) were operated on. Of 75 patients who underwent microsurgery, 20 required adjuvant gamma knife radiosurgery (GKR) for residual/recurrent lesion. Also, 42 patients underwent GKR.

Results: JFTs in cerebellopontine angle were operated on by a retrosigmoid route, and those extending extracranially had a cervical route operation. JFTs extending both extra- and intracranially were operated on by a combined suboccipital intralabyrinthine approach. In cases of glomus, the sigmoid sinus and the IJV were ligated beyond the tumor and resection was carried out. The tumor in the extracranial location was approached first followed by the tumor in the foramen and finally the intracranial component. In patients of JFT with intact caudal cranial nerve function, the tumor in the jugular foramen was left and treated with GKR. Primary GK surgery was used in cases with small glomus jugulare tumors and in patients with advanced age and medical infirmity. Tumor control has been achieved with all the tumors after GKR. Moreover, this combined modality resulted in better functional outcome and reduced postoperative morbidity. There was no operative morality.

Conclusion: Individualizing the surgical approach for JFT results in best functional outcome. GKR may be a good option in certain situations.