Primary meningiomas of the jugular fossa

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Object. Primary jugular fossa meningomas (JFMs) are one of the rarest subgroups of meningioma, with fewer than 40 cases reported in the literature. The authors retrospectively analyzed the results of surgical treatment in their series of patients, including clinical, pathological, and complication features. The surgical approach was mandated by the pathological anatomy of the tumor as well as by the anatomy of the individual patient.

Methods. During a 6.5-year period, the authors performed nine surgeries in eight patients (seven women [88%] and one man [12%]) with JFMs. Six lesions occurred on the right side and two on the left. The most common presenting symptoms were altered hearing in five patients (62%), swallowing difficulties in four patients (50%), and a deficit of the 11th cranial nerve in three patients (38%); a combination of two or more signs or symptoms was common. The surgical approach was tailored to the local anatomy (tumor—neurovascular relationships) found in each patient; three different routes were used. Radical tumor removal was achieved in all patients; one tumor recurrence occurred after 20 months in a patient in whom the tumor had displayed atypical histological features. This woman underwent a second operation. The mean length of hospital stay was 1 week. The mean and the median follow-up period were 45 and 40 months, respectively. The most common complications were transient lower cranial nerve deficits, which resolved or were compensated for in all patients within 1 month.

Conclusions. With a careful, extensive preoperative evaluation and appropriate tailoring of the operative approach, JFMs can be radically resected with the expectation of good outcome.

Article Information

Address reprint requests to: Ossama Al-Mefty, M.D., Professor and Chairman, Department of Neurosurgery, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 507, Little Rock, Arkansas 72205. email: almeftyossama@uams.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Artist's rendering of the three approaches used for resection of JFMs in this series (right side is shown).

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    Drawing of the suprajugular approach. Note the infralabyrinthine position of the tumor; the SS; the JB, which is patent; the JV; the superior petrosal sinus (SPS); and the labyrinth (right side is shown).

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    Drawing of the retrojugular approach. Note the retrojugular position of the tumor covered by the arachnoid membrane, the SS, seventh and eighth cranial nerves, and lower cranial nerves (ninth–11th nerves) stretched over the tumor (right side is shown).

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    Drawing of the transjugular approach. Note the tumor occluding the JB, which is open; the SS and JV, both of which are ligated; the SPS; the internal carotid artery (ICA); the lower cranial nerves (ninth–11th nerves) extracranially; and the labyrinth (right side is shown).

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    Photographs of dry anatomical specimens from the right side. Upper: Anterior perspective, in which the view extends from the outside to the inside, delineating the jugular foramen (white arrows) and jugular fossa (black arrows). Lower: Posterior perspective, in which the view extends from the inside to the outside, delineating the jugular foramen (black arrows) and jugular fossa (white arrows). Note the difference between the two perspectives.

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    Case 3. Neuroimages obtained in a patient with a meningotheliomatous meningioma with atypical features who required a second operation for tumor recurrence 20 months after the initial surgery. Upper: Images obtained before the first surgery. Upper Left: Axial contrast-enhanced MR image (upper portion of panel) revealing the right jugular fossa tumor (asterisk) and axial CT scan (bone window) (lower portion of panel) demonstrating tumor extension and enlargement of the jugular fossa (arrows). Upper Right: Preoperative MR angiogram obtained during the venous phase (coronal reprojection image) demonstrating the patent bilateral transverse sinuses (TS), SSs, JB, and JVs. Because the SS and JB on the side of the tumor were patent, and the tumor extended superiorly, we tailored this surgery by using the suprajugular route. Center: Axial (left) and coronal (right) contrast-enhanced MR images obtained before the second surgery for tumor recurrence. Asterisks indicate the right jugular fossa tumor extending more posteriorly. This surgery was performed through the retrojugular route. Lower: Axial (left) and coronal (right) contrast-enhanced MR images obtained after the reoperation demonstrating radical tumor resection on the right side.

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    Case 5. Upper: Preoperative contrast-enhanced coronal (left) and axial (center) MR images revealing the right jugular fossa tumor (asterisks) extending predominantly posteriorly. Magnetic resonance angiogram (right) obtained during the venous phase demonstrating the patent, bilateral transverse—sigmoid sinuses (dominant on the left side). Because the ipsilateral JB was patent, this tumor was approached via the retrojugular route. Lower: Postoperative axial images. A CT scan (bone window) (left) demonstrating the amount of right condyle resection (approximately one third was enough) and a contrast-enhanced MR image (right) confirming the radical tumor resection on the right side.

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    Case 6. Upper: Preoperative contrast-enhanced coronal (left) and axial (right) MR images revealing the right jugular fossa tumor (asterisks). Center: Additional preoperative images including CT scans (bone window) demonstrating bone invasion (hyperostosis) by tumor (asterisk) (left: upper half depicts axial and lower half coronal reconstructions) and axial image of an MR angiogram obtained during the venous phase. Note the occluded JB on the right side, ipsilateral to the tumor. This approach was tailored via the transjugular route. Lower: Postoperative images including axial contrast-enhanced MR image (left) demonstrating radical tumor resection (right side of panel) and CT scans (bone window) (right) confirming that the radical resection of the tumor involved bone (right: upper half shows axial and lower half coronal reconstructions).

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