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Samii Madjid; Tatagiba, Marcos
Neurosurgery Quarterly: September 1996
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Summary:

The region of the jugular foramen represents one of the most complex areas of the skull base. Advances in radiology, microsurgery, interdisciplinary management, and postoperative intensive care have brought great changes in treatment of the tumors affecting this region. Surgical treatment has been considered the current preferred management in the majority of the cases. Tumors involving the jugular foramen are divided into two major groups: those arising within the foramen, such as the schwannomas of cranial nerves IX, X, and XI, and the glomus jugulare tumors; and those arising from structures surrounding the foramen, such as meningiomas, chondrosarcomas, metastases, etc. The choice of surgical approach depends on the nature and extension of the lesion. Benign well-encapsulated tumors are resected totally, with potential preservation of surrounding nerves. Inversely, infiltrative growing or malignant tumors are partially resected in order to decompress the surrounding structures. Two major approaches are performed: a primary intradural suboccipital approach and a combined intradural-extradural procedure through a transmastoid-cervical approach. Radiotherapy is reserved for single cases in which surgery is not indicated. Preoperative embolization has been shown to be very useful in management of glomus jugulare tumors. CSF leakage, meningitis, and swallowing problems are the major potential complications in jugular foramen surgery. Both prevention and treatment of the complications have considerably improved the postoperative outcome in these patients.

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