JUGULAR FORAMEN MENINGIOMA
Jugular Foramen Meningioma
Jugular foramen Meningiomas are complex tumors extending from the foramen magnum to the jugular foramen. The foramen magnum is the opening in the skull that communicates the intracranial compartment to the cervical spine compartment. When the brainstem passes through the foramen magnum it becomes the uppermost spinal cord. The jugular foramen is an opening at the skull base where the cranial nerves responsible for swallowing and voice pass from the intracranial compartment to the neck before traveling to the larynx and pharynx.
Meningiomas arising from the meninges around the jugular foramen and foramen magnum compress the brainstem and upper cervical spinal cord and engulf or displace nerves for swallowing, the tongue, and the vocal cord. Those are the cranial nerves IX, X, XI, and XII. In addition, the tumor engulfs the vertebral artery which provides blood supply to the parts of the brain in the back of the head.
Symptoms
Foramen jugular Meningiomas tend to present initially with headaches in the back of the head. As the tumor progresses, the patient may develop swallowing difficulties and voice changes. With further progression and associated compression of the brainstem and the spinal cord, it can cause mild to severe motor weakness. The weakness can be unilateral or bilateral involving the upper and lower exterminates. The patient can also develop numbness in the upper and lower extremities. With further progression, the patient can become bedridden with quadriplegia associated with swallowing difficulties and dysphonia.
Treatment
Symptomatic foramen magnum Meningiomas, in general, need surgical intervention. Smaller tumors may be treated primarily with CiberKnife radiation therapy or Proton bean Radiation Therapy. Incidental tumors in elderly patients may be managed with observation with surveillance MRIs.
Surgical Treatment at the Meningioma Center
Jugular foramen Meningiomas are approached through a unilateral craniotomy around the foramen magnum which extends sideways towards the sigmoid sinus and jugular foramen. A unilateral laminectomy of the first vertebra is added and access is gained to the confined area of the jugular foramen and foramen magnum. At the Meningioma Center, we refined a focused approach through a lazy S incision in the back of the head. The approach allows extradural access to the origin of the tumor without retraction or manipulation of the brainstem, spinal cord, or cerebellum. The approach allows for the vertebral artery to be identified prior to any removal of the tumor enhancing safe tumor dissection without injury to this major artery to the brain. Moreover, it offers the potential for maximal resection of the tumor with the least loss of function.
Small tumor parts at the unfavorable hazardous positions in the foramen magnum may not be resected to avoid injury to the cranial nerves with disabling post-operative swallowing and vocal cord neurological deficits. Postoperatively residual tumor can be treated with CiberKnife Radiation Therapy or Proton Bean Radiation Therapy
Prognosis
Treatment of foramen jugular Meningiomas through a focused combined Cervico-foramen magnum approach enhances chances of maximal tumor removal with function preservation or recovery of function. Moreover, patients have the potential for returning to their lifestyle and job occupation. Small tumor parts at the unfavorable hazardous positions in the jugular foramen are unlikely to be resected during surgery. Patients with swallowing difficulties are treated with a temporary feeding tube. A post-operative residual tumor can be treated with CiberKnife Radiation Therapy or Proton Bean Radiation Therapy. Multidisciplinary approach At the Meningioma Center maximizes the potential for favorable functional outcomes and cure or control of jugular foramen Meningiomas without recurrence
Jugular Foramen Meningioma
Jugular foramen Meningiomas are complex tumors extending from the foramen magnum to the jugular foramen. The foramen magnum is the opening in the skull that communicates the intracranial compartment to the cervical spine compartment. When the brainstem passes through the foramen magnum it becomes the uppermost spinal cord. The jugular foramen is an opening at the skull base where the cranial nerves responsible for swallowing and voice pass from the intracranial compartment to the neck before traveling to the larynx and pharynx.
Meningiomas arising from the meninges around the jugular foramen and foramen magnum compress the brainstem and upper cervical spinal cord and engulf or displace nerves for swallowing, the tongue, and the vocal cord. Those are the cranial nerves IX, X, XI, and XII. In addition, the tumor engulfs the vertebral artery which provides blood supply to the parts of the brain in the back of the head.
Symptoms
Foramen jugular Meningiomas tend to present initially with headaches in the back of the head. As the tumor progresses, the patient may develop swallowing difficulties and voice changes. With further progression and associated compression of the brainstem and the spinal cord, it can cause mild to severe motor weakness. The weakness can be unilateral or bilateral involving the upper and lower exterminates. The patient can also develop numbness in the upper and lower extremities. With further progression, the patient can become bedridden with quadriplegia associated with swallowing difficulties and dysphonia.
Treatment
Symptomatic foramen magnum Meningiomas, in general, need surgical intervention. Smaller tumors may be treated primarily with CiberKnife radiation therapy or Proton bean Radiation Therapy. Incidental tumors in elderly patients may be managed with observation with surveillance MRIs.
Surgical Treatment at the Meningioma Center
Jugular foramen Meningiomas are approached through a unilateral craniotomy around the foramen magnum which extends sideways towards the sigmoid sinus and jugular foramen. A unilateral laminectomy of the first vertebra is added and access is gained to the confined area of the jugular foramen and foramen magnum. At the Meningioma Center, we refined a focused approach through a lazy S incision in the back of the head. The approach allows extradural access to the origin of the tumor without retraction or manipulation of the brainstem, spinal cord, or cerebellum. The approach allows for the vertebral artery to be identified prior to any removal of the tumor enhancing safe tumor dissection without injury to this major artery to the brain. Moreover, it offers the potential for maximal resection of the tumor with the least loss of function.
Small tumor parts at the unfavorable hazardous positions in the foramen magnum may not be resected to avoid injury to the cranial nerves with disabling post-operative swallowing and vocal cord neurological deficits. Postoperatively residual tumor can be treated with CiberKnife Radiation Therapy or Proton Bean Radiation Therapy
Prognosis
Treatment of foramen jugular Meningiomas through a focused combined Cervico-foramen magnum approach enhances chances of maximal tumor removal with function preservation or recovery of function. Moreover, patients have the potential for returning to their lifestyle and job occupation. Small tumor parts at the unfavorable hazardous positions in the jugular foramen are unlikely to be resected during surgery. Patients with swallowing difficulties are treated with a temporary feeding tube. A post-operative residual tumor can be treated with CiberKnife Radiation Therapy or Proton Bean Radiation Therapy. Multidisciplinary approach At the Meningioma Center maximizes the potential for favorable functional outcomes and cure or control of jugular foramen Meningiomas without recurrence