Meningiomas of the jugular foramen

Introduction: Meningiomas originating from the dura of the jugular foramen (JF) are very rare. Because of the complex bone and neurovascular anatomy of the JF, these tumors represent a difficult task for treatment. This study was carried out to retrospectively evaluate the clinical aspects, surgical management and outcome of meningiomas that originate in the area of the JF. Posterior fossa meningiomas which secondarily affected the JF were not included in this series. Methods: Among 650 skull base meningiomas and 350 meningiomas of the posterior fossa which have been operated in our Department between 1978 and 1995, we found 13 cases in whom the tumor originated from the dura of the jugular foramen. Clinical and surgical records, radiological findings were evaluated, followed by a clinical and radiological follow-up. Results: JF meningiomas represented 2% of all skull base meningiomas and 3.7% of the posterior fossa meningiomas. There were 12 women and one man in this series. Duration of symptoms ranged from 3 months to 15 years; most frequent symptoms included headache, dysphagia, hoarseness, and hearing loss. Half of the patients had preoperatively hearing loss and lower cranial nerve dysfunction. Tumor size ranged from 1 × 2 cm to 4.5 to 3.5 cm. In half of the cases tumor extended upward beyond the VII-VIII cranial nerve complex. Retrosigmoid intradural with or without mastoidectomy was the usual approach for these tumors. Radical resection (Simpson I-II) was achieved in 11 cases, and subtotal resection (III-IV) in 2 cases. There was no postoperative mortality. Postoperative complications included CSF leakage which has been treated with lumbar drainage, and additional lower cranial nerve deficits. Conclusion: JF meningiomas are difficult to treat tumors because of the involvement of the lower cranial nerve and important cranial base vessels. Preoperative impairment of the cranial nerves IX-XII facilitates surgical decision making for radical resection. On the contrary, sudden postoperative worsening of preoperative intact function is not well tolerated by the patient. We therefore generally recommend radical resection in all cases, but those with infiltrative growing tumors and preoperative intact lower cranial nerve function.