Microsurgical Treatment for Primary Jugular Foramen Meningiomas

Background: Jugular foramen meningiomas (JFMs) comprise a rare subtype of intracranial meningiomas, with unique clinical manifestations, neuroimagings, and surgical treatment compared with jugular glomus and schwannoma.

Methods: Retrospective study of consecutive patients with primary JFMs treated at the Neurosurgery Center at Beijing Tiantan Hospital, Capital Medical University, from January 2004 to October 2010. The data included patients’ symptoms, signs, physical examinations, neuroimagings, operative notes, and follow-up. Surgical approaches were selected based on tumor growth manners and included the pre-sigmoid-bulb approach, retrosigmoid-bulb approach, and a combined approach that consisted of the retrosigmoid, hockey-stick, and postauricular C-shaped incision.

Result: A total of 22 patients harboring JFMs were enrolled in this study, accounting for 15.8% of non-glomus jugular tumors (139 cases). The most common symptom was hearing disorder, followed by lower cranial nerve dysfunctions. The study included 10 males and 12 females, with average age of 39.4 years (range, 14-57 years). The typing included type A (intra-foramen) in 1 patient, type B (intracranial) in 15, and type D (dumbbell) in 6; no type C (extracranial) incidents were found. The postauricular C shaped surgical approach (pre-SBA) was used in 5 cases, suboccipital retrosigmoid in 7, and submidline hockey-stick in 10. Total resections were achieved in 18 cases and subtotal in 4 cases. Malignancy of WHO grade II was found in four cases and WHO grade III in one. The neurological function dropped immediately after surgery in most cases, but recovery was gained with time. Keeping airway patency and preventing swallowing difficulty are important for postoperative management. Only one patient died of tumor regrowth due to its highly malignant nature (WHO grade 3).

Conclusion: Hearing dysfunction and lower cranial nerve dysfunction are most common symptoms for JFM patients. JFM has unique neuroimaging characteristics. Surgical approach can be classified into pre-SBA, retro-SBA, or combined. Non-benign meningiomas are quite common (∼20%), indicating surgical removal to the extent possible, and requiring close follow-up and even possible radiotherapy. Although great achievement has been made with the skull base techniques, functional preservation of the lower cranial nerve is still challenging.