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Oktay K, Aliyev A, Alcan HE, Erdogan S, Ozsoy KM, Cetinalp NE, Erman T. Extraskeletal Myxoid Chondrosarcoma of the Jugular Foramen in a Pediatric Patient: A Case Report and Comprehensive Review of the Literature. Pediatr Neurosurg 2023; 58:173-178. [PMID: 37231851 DOI: 10.1159/000530990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/28/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other pathologies. CASE PRESENTATION We report an extremely rare case of a 14-year-old female patient with jugular foramen myxoid chondrosarcoma that was completely removed through microsurgical resection. CONCLUSION The primary purpose of the treatment is gross total resection of the chondrosarcomas. However, adjuvant methods such as radiotherapy should additionally be applied in patients who have high-grade diseases or cannot undergo gross total resection because of anatomic localization.
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Affiliation(s)
- Kadir Oktay
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Araz Aliyev
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Halil Emre Alcan
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Seyda Erdogan
- Department of Pathology, Cukurova University School of Medicine, Adana, Turkey
| | - Kerem Mazhar Ozsoy
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Nuri Eralp Cetinalp
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
| | - Tahsin Erman
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
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Ota Y, Curaudeau G, Liao E, Bapuraj J, Baba A, Shah G, Srinivasan A. Precise differentiation between jugular foramen paragangliomas and metastases: utility of diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging. Neuroradiology 2023; 65:805-813. [PMID: 36635515 DOI: 10.1007/s00234-023-03113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE This study tested the utility of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE-MRI) in differentiating paragangliomas and metastases in the jugular foramen in combination with conventional imaging. METHODS Forty-nine consecutive patients with paragangliomas or metastases between January 2015 and April 2022 were included in this retrospective study. All patients had pretreatment DWI and DCE-MRI. Between paragangliomas and metastases, normalized apparent diffusion coefficient (nADCmean) and DCE-MRI parameters were compared along with conventional imaging features (enhancement pattern, presence of flow voids, cystic/necrotic change, and bone erosion). The diagnostic performance was tested using receiver operating characteristic (ROC) analysis. RESULTS Thirty-five paragangliomas (5 male; median 49 years) and 14 metastases (9 male; median 61 years) were analyzed. The most common 3 primary cancers included 4 lung cancers, 3 breast cancers, and 3 melanomas. The presence of flow void was significantly different between paragangliomas and metastases (21/35 vs 2/14; P = 0.0047) in conventional imaging features, while fractional plasma volume (Vp) was significantly different between the two tumor types (median 0.46 vs 0.19; P < 0.001) in DWI and DCE-MRI parameters. The areas under the ROC curves (AUCs) of the presence of flow void and Vp were 0.72 and 0.93, respectively. The AUC of the combination of the presence of flow void and Vp was 0.95 and significantly improved compared to that of the presence of flow void (P < 0.001). CONCLUSION Adding DCE-MRI to the head and neck protocol can aid in the precise differentiation between jugular foramen paragangliomas and metastases.
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Affiliation(s)
- Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA.
| | - Guillaume Curaudeau
- Department of Radiology, The University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Eric Liao
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Jayapalli Bapuraj
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Gaurang Shah
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
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Yamashita S, Fujita A, Kohta M, Sasayama T, Kohmura E. Bone-destructive osseous arteriovenous fistula at the jugular bulb mimicking a glomus jugular tumor. Neurochirurgie 2021; 68:525-529. [PMID: 34536438 DOI: 10.1016/j.neuchi.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/16/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some reports have described intraosseous arteriovenous fistulas showing osteolytic changes, but an osseous arteriovenous fistula (AVF) at the jugular bulb showing extensive bone destruction is a very rare disease. CASE DESCRIPTION A 60-year-old man presented with pulsatile tinnitus and right facial nerve palsy. Radiological imaging showed a large homogenously enhanced osteolytic lesion at the right jugular foramen. A cerebral angiogram showed a high-flow vascular lesion of the jugular bulb associated with retrograde sinus reflux, resulting in venous congestion of the deep venous system. These findings led us to misdiagnose this lesion as a glomus jugular tumor. However, combined arterial and venous angiography after transarterial embolization revealed the precise angioarchitecture, and we finally diagnosed this lesion as a high-flow osseous AVF at the jugular bulb. We performed transvenous embolization using a triple catheter technique. The lesion was successfully obliterated, and the 6-months angiogram showed no recurrence. CONCLUSION A rare case of high flow osseous AVF at the jugular bulb associated with osteolytic changes in the surrounding bony structure is reported. Although many hypervascular lesions at the jugular bulb are glomus tumors, bone destructive osseous AVF at the jugular bulb should be considered.
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Affiliation(s)
- S Yamashita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - A Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - M Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - T Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - E Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Yan P, Wang P. Accessory nerve schwannoma: A new case report and systematic review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ciavarro G, Bozzetti F, Falcioni M. Jugular Foramen Metastasis from Lung Cancer: A Case of "A Mass without His Syndrome". J Int Adv Otol 2019; 15:469-471. [PMID: 31257193 DOI: 10.5152/iao.2019.6540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Jugular foramen (JF) metastasis is rare and often presents as JF syndrome. A 73-year-old male complained of left-sided mastoid pain that irradiated to the neck since the past 3 months. Onset of facial nerve (FN) palsy and persistence of the symptomatology despite corticosteroid therapy demanded radiologic evaluation. Computed tomography and magnetic resonance imaging showed a wide osteolytic lesion of the left JF with involvement of the third segment of the FN. The patient underwent transmastoid incisional biopsy. Histopathological examination showed an adenocarcinoma that was suggested to be of respiratory origin. A primary pulmonary lesion and metastasis to other sits were detected. The patient died 1 month after the initiation of the chemotherapy. Persistent mastoid pain and progressive FN palsy must be considered indicative of JF malignant lesions. Despite early diagnosis, secondary lesions of the JF are characterized by a poor prognosis; however, accurate diagnosis may avoid unnecessary aggressive surgery.
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Affiliation(s)
- Giovanni Ciavarro
- Department of Medicine and Surgery, Unit of Otolaryngology and Otoneurosurgery, University-Hospital of Parma, Parma, Italy
| | - Francesca Bozzetti
- Department of Medicine and Surgery, Unit of Neuroradiology, University-Hospital of Parma, Parma, Italy
| | - Maurizio Falcioni
- Department of Medicine and Surgery, Unit of Otolaryngology and Otoneurosurgery, University-Hospital of Parma, Parma, Italy
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Jugular Foramen Meningioma. Otol Neurotol 2018; 39:e222-e223. [PMID: 29342045 DOI: 10.1097/mao.0000000000001709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.
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Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, University of Virginia, Charlottesville, VA, United States.
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Dumbbell-Shaped Jugular Foramen Tumors Extending to the Neck: Surgical Considerations Based on Imaging Findings. World Neurosurg 2017; 104:14-23. [PMID: 28499902 DOI: 10.1016/j.wneu.2017.04.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/29/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Dumbbell-shaped jugular foramen tumors (DSJFTs) extending to the neck present diagnostic and management difficulties because of their rarity, various pathologies, and multidisciplinary involvement. Accurate imaging findings are of great importance for surgical planning and clinical outcomes. However, few articles have discussed this issue to date. METHODS Thirty-one patients with DSJFTs extending to the neck were surgically treated in a single stage at our institute. Their clinical and radiologic features, operative procedures, and outcomes were retrospectively reviewed. RESULTS Preoperative correct diagnosis of DSJFTs extending to the neck was made in all cases of benign tumor and in only 3 cases of malignant tumors in this series. All tumors were removed via a craniocervical approach by a multidisciplinary skull base team because of both their intracranial and neck extensions. Total removal was achieved in 26 patients (83.9%). Preoperative symptoms were improved in 18 patients, whereas new or worsening lower cranial nerve deficits occurred in 4 patients postoperatively. Follow-up (1-132 months, mean 64.4 months) was available in 90.3% of the patients. No clinical or radiologic signs of tumor recurrence were observed. CONCLUSIONS Preoperative radiologic evaluation of DSJFTs extending to the neck is essential for differential diagnosis, patient selection, and surgical planning. Favorable surgical outcomes can be achieved via a craniocervical approach, and some detailed imaging findings are helpful to increase the safety of tumor resection and reduce the morbidity of lower cranial nerve deficits and cerebrospinal fluid leakage.
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Erkan S, Somner J, Rajan GP. Sunitinib as Neoadjuvant Chemotherapy in the Management of Metastatic Renal Cell Carcinoma Mimicking a Glomus Vagale Tumor in the Head and Neck: A Case Report and Review of Literature. J Neurol Surg Rep 2016; 77:e77-82. [PMID: 27247912 PMCID: PMC4882188 DOI: 10.1055/s-0036-1579629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Metastatic renal cell carcinoma (RCC) of the head and neck with intracranial extension is rare and may pose difficulties to the diagnosis and management. Method We describe a unique case of a 76-year-old man with a metastatic RCC to the neck and lateral skull base with intracranial extension presenting with Collet-Sicard syndrome 8 years after initial diagnosis. The radiologic features were consistent with the diagnosis of a glomus vagale tumor on the basis of clinical and radiologic features. Results Despite radiotherapy, the intracranial extension progressed in size, resulting in early hydrocephalus. Sunitinib, a novel tyrosine kinase inhibitor, was instituted to treat the glomus vagale tumor with a marked reduction in tumor volume and resolution of the early hydrocephalus. The surgical resection of the tumor with its intracranial extension was achieved without additional postoperative morbidity. The histopathologic diagnosis surprisingly demonstrated metastatic RCC. Conclusion We present a case of metastatic RCC to the head and neck region mimicking a glomus vagale tumor and describe the first use of sunitinib as a neoadjuvant chemotherapy to achieve a single-stage radical en bloc resection of the tumor mass.
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Affiliation(s)
- Serkan Erkan
- Department of Otolaryngology, Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jessica Somner
- Department of Otolaryngology, Head and Neck Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Department of Otolaryngology, Head and Neck Surgery, School of Surgery, University of Western Australia, Murdoch, Western Australia, Australia
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Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Non-paraganglioma tumors of the jugular foramen – Growth patterns, radiological presentation, differential diagnosis. Neurol Neurochir Pol 2015; 49:156-63. [DOI: 10.1016/j.pjnns.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/29/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
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Petrović S, Grozdanović D, Kovačević P, Višnjić M, Petrović D. Collet Sicard syndrome as atypical presentation of neck fibrosarcoma: a case report. Bosn J Basic Med Sci 2011; 11:137-40. [PMID: 21619564 DOI: 10.17305/bjbms.2011.2600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a 57 years old female patient with neck fibrosarcoma. Her main complaints consisted of hoarseness, difficulty swallowing, pain in the left side of her neck and left shoulder region, which all indicated the Collet Sicard syndrome, so the working diagnosis was glomus tumor. Diagnostic MSCT was used, and the characteristics of the radiologic finding did not indicate any of the paraganglioma types, although the tumor was localized in the area of the carotid bifurcation, demonstrating the signs of extension into the jugular foramen. The patient has been treated surgically in general anesthesia and pathologic diagnosis was fibrosarcoma.
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Affiliation(s)
- Slađana Petrović
- Center for Radiology, University of Niš Faculty of Medicine, Serbia.
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Abstract
The anatomy of the jugular foramen is complex. It contains the lower cranial nerves and major vascular structures. Tumors that develop within it, or extend into it, provide significant diagnostic and surgical challenges. In this article, we describe the anatomy of the jugular foramen and outline an imaging protocol that can differentiate between lesions, thereby aiding diagnosis and facilitating management.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Clinic, Frankfurt am Main, Germany
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The glossopharyngeal, vagus and spinal accessory nerves. Eur J Radiol 2010; 74:359-67. [PMID: 20233644 DOI: 10.1016/j.ejrad.2009.05.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/06/2009] [Indexed: 11/21/2022]
Abstract
The glossopharyngeal, vagus and spinal accessory nerves are closely related anatomically, and to a certain extent, functionally. We present an overview of their anatomy, highlighting the important clinical and imaging implications. The main pathologic lesions arising from these nerves are also discussed and the imaging features reviewed.
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Christie A, Teasdale E. A comparative review of multidetector CT angiography and MRI in the diagnosis of jugular foramen lesions. Clin Radiol 2010; 65:213-7. [PMID: 20152277 DOI: 10.1016/j.crad.2009.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 11/02/2009] [Accepted: 11/08/2009] [Indexed: 10/20/2022]
Abstract
AIM To compare the efficiency of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the diagnosis of jugular foramen lesions. MATERIALS AND METHODS The imaging of 15 patients with tumours predominantly occurring at the jugular foramen was retrospectively reviewed, with postoperative pathology data available for 11 patients. MDCT was performed at arterial phase and MRI with standard sequences and contrast enhancement. All imaging was blindly re-reported by an experienced neuroradiologist. RESULTS Pathology reported six glomus jugulare tumours and five neuromas, which were all correctly diagnosed using MDCT. A confident diagnosis was also made in the remaining four cases based on the pattern of enhancement. Only glomus tumours enhanced in the arterial phase. Overall, MRI was used to make a confident diagnosis in eight patients. One showed no enhancement and was correctly diagnosed as a neuroma, and seven demonstrated the tumour flow voids characteristic of a glomus tumour. The remaining seven cases all showed a similar enhancement pattern and could not be confidently differentiated between a neuroma or a glomus tumour. MDCT angiography enabled a confident assessment of the jugular vein in all cases, but MRI was inconclusive in a third of cases. Also, in the nine cases of glomus tumour diagnosed using MDCT, an enlarged feeding artery was identified in eight patients. CONCLUSION MDCT is more accurate than MRI in diagnosing glomus tumours, and in particular, neuromas. It also offers valuable preoperative vascular information to the surgeon.
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Affiliation(s)
- A Christie
- Radiology Department, Institute of Neurosciences, Glasgow, Scotland, UK.
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Diffusion-weighted imaging and ADC mapping of head-and-neck paragangliomas: initial experience. ACTA ACUST UNITED AC 2009; 19:215-9. [PMID: 19705076 DOI: 10.1007/s00062-009-9004-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 06/02/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Paragangliomas are rare, hypervascularized benign tumors. In some cases a clear differentiation of paragangliomas and other entities is impossible. PATIENTS AND METHODS The authors evaluated ten patients with skull base lesions (paraganglioma n = 7, meningioma n = 1, giant cell tumor n = 1, and neurinoma n = 1) in addition to conventional magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), and calculation of apparent diffusion coefficient (ADC). RESULTS Mean ADC values +/- standard deviation of the paragangliomas were 1.304 +/- 0.257 x 10(-3) mm(2)/s and differed from ADC values of the other jugular fossa tumors with 0.743 +/- 0.108 x 10(-3) mm(2)/s and measurement derived from the cerebellum with 0.802 +/- 0.075 x 10(-3) mm(2)/s. CONCLUSION Due to the difference of ADC values, the authors propose that DWI and ADC mapping could be a promising tool in the diagnostic work-up of paragangliomas.
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Primary Ewing's sarcoma: peripheral primitive neuroectodermal tumour of the jugular foramen. Acta Neurochir (Wien) 2008; 150:817-21. [PMID: 18548190 DOI: 10.1007/s00701-008-1601-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 04/17/2008] [Indexed: 10/22/2022]
Abstract
We describe an extremely rare example of Ewing's sarcoma (ES)/peripheral primitive neuroectodermal tumour (pPNET) originating from the jugular foramen. The patient was a 10-year-old boy who presented with progressive symptoms due to right lower cranial nerve palsies. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) revealed a tumour at the right jugular foramen which showed extra-cranial extension. Open biopsy of the extra-cranial lesion was performed, and diagnosis of ES/pPNET was made by histopathological, immunohistochemical and genetic investigations. The patient received a combination of multi-drug chemotherapy and irradiation. By 12 months after the diagnosis, MRI showed complete remission of the lesion, and the patient has been well apart from slight dysphagia. Previously, there was only one report of a jugular foramen ES/pPNET and in which treatment had failed. To our best knowledge, this is the first patient treated successfully with chemoradiotherapy.
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Szymańska A, Gołabek W, Szymański M, Morshed K, Trojanowska A. [Diagnostic evaluation of temporal paragangliomas]. Otolaryngol Pol 2008; 61:931-6. [PMID: 18546938 DOI: 10.1016/s0030-6657(07)70556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Paragangliomas are rare tumours deriving from paraganglia--small bodies of neuroendocrine tissue. Approximately 3% of paragangliomas occur in the head and neck area accounting for about 0,6% of all tumours of this region. Head and neck paragangliomas are divided into two groups: neck tumours (carotid body tumor and vagal paraganglioma) and temporal paragangliomas (jugular bulb tumor and tympanic paraganglioma). Temporal paragangliomas arise from paraganglia located in the petrous part of the temporal bone. Radiological evaluation of these lesions is essential for confirming the diagnosis and surgery planning. Most useful methods are magnetic resonance imaging and computed tomography. These modalities deliver important information about tumour location, extension and the state of the surrounding structures. Carotid angiography is a second step diagnostic method, performed in patients with jugular bulb paraganglioma. It has a diagnostic value and allows palliative or preoperative embolization of the tumor. Ultrasonographic evaluation and scintigraphy also provide advantages in diagnostic management.
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Affiliation(s)
- Anna Szymańska
- Zaklad Radiologii Zabiegowej i Neuroradiologii AM w Lublinie.
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Straetmans J, Stokroos R. Extramedullary plasmacytomas in the head and neck region. Eur Arch Otorhinolaryngol 2008; 265:1417-23. [PMID: 18299869 DOI: 10.1007/s00405-008-0613-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 02/08/2008] [Indexed: 11/25/2022]
Abstract
Extramedullary plasmacytoma (EMP) arises outside the bone marrow, particularly in the head and neck region (nasopharynx, nose cavity, sinuses, and tonsils), and can be associated with multiple myeloma (MM). Three cases of EMP in the head and neck region are described: a first case describes an EMP of the subglottis 3 years after treatment of MM, a second case of an EMP solitary in the middle ear presenting as a jugular foramen syndrome, and a third case of an EMP localised at the epiglottis, recurring at the floor of the nose cavity. Treatment of each EMP was surgical. We reviewed literature about aetiology, clinical course, diagnostics, treatment and prognosis. Important presenting symptoms vary from epistaxis, rhinorrhoea, a sore throat, dysphonia to haemoptoea. Association with MM must be confirmed or excluded. Histopathological examination, with immunological staining or flow cytometry confirms the diagnosis. CT and MRI are useful in staging EMP. The treatment of EMP is surgery and/or radiotherapy. The prognosis depends on tumour size (>5 cm) and nodal involvement. The 10-year survival rate is 50-80%.
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Affiliation(s)
- Jos Straetmans
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Maastricht, P. Debyelaan 25, P.O Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Martin JJ, Kondziolka D, Flickinger JC, Mathieu D, Niranjan A, Lunsford LD. Cranial nerve preservation and outcomes after stereotactic radiosurgery for jugular foramen schwannomas. Neurosurgery 2007; 61:76-81; discussion 81. [PMID: 17621021 DOI: 10.1227/01.neu.0000279726.90650.6d] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Jugular foramen region schwannomas are rare intracranial tumors that usually present with multiple lower cranial nerve deficits. For some patients, complete surgical resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery is a minimally invasive alternative or adjunct to microsurgery for such tumors. We reviewed our clinical and imaging outcomes after patients underwent gamma knife radiosurgery for management of jugular foramen schwannomas. METHODS Thirty-four patients with 35 tumors (one patient had bilateral tumors) underwent radiosurgery between May 1990 and December 2005. Twenty-two patients had previous microsurgical resection and all patients experienced various cranial neuropathies. A median of six isocenters were used. Median marginal and maximum doses were 14 and 28 Gy, respectively. RESULTS None of the patients were lost to evaluation and the mean duration of follow-up was 83 months. Tumors regressed in 17 patients, remained stable in 16, and progressed in two. Five- and 10-year actuarial control rates were 97 and 94%, respectively. Preexisting cranial neuropathies improved in 20% and remained stable in 77% after radiosurgery. One patient worsened. The function of all previous intact nerves was preserved after radiosurgery. CONCLUSION Stereotactic radiosurgery proved to be a safe and effective management for newly diagnosed or residual jugular foramen schwannomas. Long-term tumor control rates and stability or improvement in cranial nerve function was confirmed.
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Affiliation(s)
- Juan J Martin
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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