Jugulare Foramen Surgery: In the Era of Radiotherapy

Background: Jugular foramen tumors are rare skull base tumors having complex neurovascular anatomy. Being the conduit for important neuro-vascular structures, potential complications following surgery are a frequent source of morbidity. With the advent of Stereotactic radio surgery (SRS) there has been a paradigm shift of conservative management of these tumors. We present our experience in jugular foramen lesions and importance of surgical excision.

Method and Materials: Retrospective chart review of 25 patients from March 2008 to September 2014, who were operated for lesions involving the jugular foramen, was done. All patients were evaluated in detail by a neurosurgeon and neuro-otologist. All patients underwent high resolution computer tomography (HRCT) of temporal bones and magnetic resonance imaging (MRI) with angiography in preoperative period. Surgical approach and pre-operative endovascular intervention depended on the site and extent of the lesion. Extent of tumor removal was determined at the time of surgery. Patients with incomplete excisions in postoperative imaging were subjected to radiotherapy.

Results: The histopathological diagnosis of jugulare foramen tumors included glomus jugulare(n = 19), schwannoma(n = 3), meningioma(n = 1), plasmacytoma(n = 1) and squamous cell carcinoma(n = 1). Eighth cranial nerve was the most common involved nerve preoperatively (100%). Infratemporal Fossa approach, along with its modification, and conservative jugulopetrosectomy approach were used for surgical excision as per the extent of tumor. Complete excision was done in 52% (n = 13), and radiotherapy was given to rest of the patients. The most common postoperative complication was lower cranial nerve deficit. (n = 15, 60%).

Conclusion: Surgical management depends on the extent of tumor. Radiotherapy should be used as an adjuvant therapy and not as a primary modality as lesions in jugulare foramen can present as different histopathological outcomes. Proper perioperative preparation can help in adequate surgical excision and avoid the need of radiotherapy.