Chondrosarcoma of the Jugular Foramen: A Case Report

The vast majority of chondrosarcomas of the skull (CS) are located at the skull base and represent locally aggressive malignant tumors that account for 0.15% of all intracranial neoplasms. Complete surgical resection with wide surgical margins is currently the main treatment strategy, but can be hard to achieve due to the complex anatomy of the head and neck. The jugular foramen, situated in the floor of the posterior fossa and posterolaterally to the petro-occipital suture, is a remarkably rare location for CS. A case of primary CS of the jugular foramen in a 65-year-old patient is reported, presenting with otalgia, pulsatile tinnitus, and mild hearing loss in the left ear, accompanied by peripheral facial nerve paresis. Radiographic imaging showed a mass in the left mastoid, middle ear and jugular fossa with bone destruction of the jugular fossa and mastoid, while magnetic resonance imaging showed additional involvement of the petroclival fissure, hypoglossal canal, jugular bulb, and sigmoid sinus. The tumor was resected with wide margins through a Fisch infratemporal fossa approach type A, followed by radiotherapy. Results of the immunophenotyping along with histological features primarily matched moderately differentiated chondrosarcoma. The patient is recurrence free at 6 months after treatment. Middle ear discharge with facial palsy as a first manifestation of the CS has not been described to date. The unique localization, treatment details and histopathologic data are relevant in expanding the current level of knowledge on the subject.