Anatomy Involved in the Jugular Foramen Approach
The goal in paraganglioma resection is to allow adequate exposure to remove the lesion while preserving cranial nerve function. Knowledge of the anatomy of the jugular foramen is crucial to this endeavor. In this report the authors describe a jugular foramen approach for the resection of glomus jugulare tumors in cases in which rerouting of the facial nerve can be avoided. This approach provides adequate exposure of the jugular bulb for many jugulotympanic paragangliomas without increased risk of injury to the facial nerve. In addition, special circumstances surrounding intracranial and carotid artery involvement are briefly discussed.
Paragangliomas are tumors derived from the neural crest that arise from the extraadrenal paraganglia of the autonomic nervous system. The most common para ganglioma of the head and neck is the carotid body tumor, followed by the jugulotympanic paraganglioma. These are benign tumors that grow slowly, but they can be locally aggressive. Because of their insidious growth pattern, they are often not diagnosed until they reach an advanced stage. High-resolution computerized tomography scanning and magnetic resonance imaging are essential in the diagnosis and characterization of these lesions. Whereas magnetic resonance imaging is superior in its ability to define the relationship of the lesion to the surrounding vessels, computerized tomography scanning can help define osseus erosion by the tumor.
The risk of neurovascular injury is an important consideration in the treatment of these tumors. Therefore, definitive management is carefully considered with regard to the size and extent of the lesion, as are patient-related issues such as age, physical condition, and preoperative nerve function. Knowledge of the anatomical landmarks and surgical techniques is crucial to a successful resection.
The goal in paraganglioma resection is to allow adequate exposure to remove the lesion while preserving cranial nerve function. Knowledge of the anatomy of the jugular foramen is crucial to this endeavor. In this report the authors describe a jugular foramen approach for the resection of glomus jugulare tumors in cases in which rerouting of the facial nerve can be avoided. This approach provides adequate exposure of the jugular bulb for many jugulotympanic paragangliomas without increased risk of injury to the facial nerve. In addition, special circumstances surrounding intracranial and carotid artery involvement are briefly discussed.
Paragangliomas are tumors derived from the neural crest that arise from the extraadrenal paraganglia of the autonomic nervous system. The most common para ganglioma of the head and neck is the carotid body tumor, followed by the jugulotympanic paraganglioma. These are benign tumors that grow slowly, but they can be locally aggressive. Because of their insidious growth pattern, they are often not diagnosed until they reach an advanced stage. High-resolution computerized tomography scanning and magnetic resonance imaging are essential in the diagnosis and characterization of these lesions. Whereas magnetic resonance imaging is superior in its ability to define the relationship of the lesion to the surrounding vessels, computerized tomography scanning can help define osseus erosion by the tumor.
The risk of neurovascular injury is an important consideration in the treatment of these tumors. Therefore, definitive management is carefully considered with regard to the size and extent of the lesion, as are patient-related issues such as age, physical condition, and preoperative nerve function. Knowledge of the anatomical landmarks and surgical techniques is crucial to a successful resection.
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