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Primary meningiomas of the jugular fossa
Kenan I Arnautović1, Ossama Al-Mefty
1Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
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.
Insights
Surgical resection of primary jugular fossa meningomas (JFMs) is feasible. Careful preoperative evaluation and tailored surgical approaches lead to radical tumor removal and good outcomes for these rare tumors.
Area of Science:
- Neurosurgery
- Oncology
- Skull Base Surgery
Background:
- Primary jugular fossa meningomas (JFMs) are exceptionally rare, with fewer than 40 cases documented.
- These tumors present unique surgical challenges due to their location and proximity to critical neurovascular structures.
Purpose of the Study:
- To retrospectively analyze the surgical treatment outcomes for a series of patients with JFMs.
- To detail the clinical, pathological, and complication features associated with JFM surgical management.
Main Methods:
- Nine surgeries were performed on eight patients with JFMs over a 6.5-year period.
- Surgical approaches were individualized based on tumor anatomy and patient-specific factors, utilizing three distinct routes.
- Tumor characteristics, presenting symptoms, surgical techniques, and postoperative outcomes were reviewed.
Main Results:
- Radical tumor removal was achieved in all patients.
- The most common symptoms included hearing alteration, swallowing difficulties, and 11th cranial nerve deficits.
- Transient lower cranial nerve deficits were the most frequent complications, resolving within one month.
Conclusions:
- Careful preoperative assessment and tailored surgical strategies are crucial for successful JFM resection.
- Radical resection of JFMs can be achieved with favorable outcomes, despite their rarity and complex anatomy.