Temporal Bone Malignancies Involving The Jugular Foramen:Clinical Characteristics

Objective:To report the clinical manifestations, imaging characteristics, surgical approaches, and treatment outcome of temporal bone malignancies involving the jugular foramen. And describe the influence of preoperative estimation, perioperative management, surgical approaches on the significance of total lesion resection and preventing complications.Subjects and Methods:The charts of10patients with temporal bone malignancies involving the jugular foramen in Eye Ear Nose&Throat Hospital of Fudan University from October2006to October2012were reviewed. Among them, the pathological diagnoses were as follows:6cases of squamous cell carcinoma,2cases of adenoid cystic carcinoma,1case of ceruminous adenocarcinoma, and1case of chondrosarcoma. The presentation symptoms, results of the neurotologic examinations, hearing threshold and image study, management, and follow-up data were recorded. The most frequent symptoms were conductive hearing loss (80%), otorrhea (70%), and otalgia (60%). In addition to the jugular foramen, the most invasive structure was the external auditory canal (90%), followed by the middle ear (80%) and facial nerve (70%). Three (30%) patients experienced misdiagnoses.5cases were operated on by trans-mastoid and neck approach, and5cases underwent modified infratemporal fossa approachResults:The mean follow-up time was21.3months (range,2-79months). During this time,4patients died. The overall survival rate was60%. One patient experienced facial nerve paresis (H-B IV) postoperatively, and we did not perform any facial nerve grafting. One patient complained of hoarseness, dysphagia, dysfunction of tongue movement, and shoulder weakness after embolization. For another patient, his shoulder weakness became worse after radiotherapy. One patient experienced postoperative cerebrospinal fluid leakage, which was managed successfully with a conservative strategy.Conclusion:Temporal bone malignancies involving the jugular foramen is very rare and aggressive tumors. The misdiagnosis of temporal bone malignancies involving the jugular foramen frequently occurs because of the wide but not peculiar clinical spectrum. The jugular foramen is deep located, and provides significant diagnostic and surgical challenges. The choice of the optimal surgical approach for each case should be individualized and based on the size and location of the tumor, involved structures, degree of hearing loss, lower cranial nerves, and surgeon’s experience. Preserve the lower cranial nerves and facial nerve as much as possible. Temporal bone malignancies involving the jugular foramen have a very poor prognosis, especially for the squamous cell carcinoma. Patients with recurrent tumors had lower survival rates. This is important to keep in mind, as treatment planning must ensure complete eradication of disease on the first attempt. Adjuvant radiotherapy or chemotherapy following surgery is recommended.