Operative Treatment And Prognosis Of Tumors In Jugular Foramen Region

ObjectiveThis study was designed to explore the clinical features,imaging characteristics,operative treatment and its effects on jugular foramen tumors,especially different pathological types,moreover,to analyze the influence of preoperative estimation and the related risk factors on prognosis.MethodsRetrospective analysis of 72 patients with tumor in jugular foramen region(JFR),who had been diagnosed and treated from Sep,2005 to April 2016,in Shandong Provincial Hospital(West Campus).All patients had been executed with imaging test,including CT、MRI and CTA.Moreover,angiography and blood-supply vessel’s embolization were chosen when needed.All patients had undergone operation,and the prognosis was evaluated after 10 to 137 months follow-up.Clinical features,imaging characteristics,tumor stages,pathological pattern and therapeutic effect were analyzed and compared between pre-and post-operation;different operative approaches and their prognosis were analyzed among various tumors;the recurrence rates of different tumors in JFR were analyzed;logistic regression analysis was adopted to evaluate the correlation between possible factors and prognosis,such as tumor stages,pathological pattern,scope of surgery,facial paralyses,injure of lower cranial nerves,age and so on.ResultsIn 72 patients,age was ranged from 22 to 84 years old,the average was 46.7.The number of female was more than male,with 37 to 35.The follow-up time was 61.32 ± 39.02 months(10～137 months).The primary symptoms were pulsatile tinnitus(48.6%),hearing loss(62.5%)peripheral facial paralysis(37.5%),neck mass(6.9%),lower cranial neuropathy,including hoarseness(20.8%),cough(20.8%);tongue deviation(22.2%),uranoplegia(19.4%),headache(13.9%),equilibrium disorder(19.4%),discharge of external auditory canal(20.8%)and otalgia(16.7%).According to Fisch classification,patients were all classified above stage C.All the tumors had been executed operation via different approaches,including infratemporal fossa approach(66 cases),infratemporal fossa approach united retrolabyrinthine approach(2 cases),infratemporal fossa approach united retrosigmoid approach(3 cases),infratemporal fossa approach united translabyrinthine approach(1 case).60 cases were totally removed,12 were partly removed,the total removal rate was 83.3%(60/72).The pathologic result demonstrated that paraganglioma(31 cases,43.1%),schwannoma(11 cases,16.7%),meningeoma(4 cases,5.6%),chondrosarcoma(5 cases,6.9%),endolymphatic sac adenoma(4 cases,5.6%),neurofibroma(4 cases,5.6%),squamous carcinoma(2 cases,2.8%),adenocarcinoma(4 cases,5,6%),giant-cell tumor(1 case,1.4%),plasmacytoma(1 case,1.4%),malignant paraganglioma(2 cases,2.8%),osteoblastoma(1 case,1.4%),fibrous dysplasia of bone(1 case,1.4%).One patient died during the perioperative period.Hearing loss,facial paralysis and lower cranial neuropathy can be exacerbated post-operation,according to different cases,hearing loss was irreversible,neurological signs could gradually alleviate post-operation.Pulsatile tinnitus in paraganglioma can be alleviated in most cases.The recurrence rates involved paraganglioma(13.0%),schwannoma(8.3%);after total resection,the recurrence rates were 9.5%,0 respectively;after subtotal resection,the recurrence rates were 50.0%,33.3%respectively.7 cases died,including squamous carcinoma(2 cases),adenocarcinoma(1 case),plasmacytoma(1 case),malignant paraganglioma(1 case),anaplastic meningeoma(1 case),neurofibroma(1 case).With regard to the prognostic factors,facial paralysis,lower cranial neuropathy,malignant pathological pattern and incomplete resection were risk factors for recurrence(P<0.05).Conclusions1.Paraganglioma and schwannoma are most common in tumor in JFR,as well some specific types.2.Normative preoperative assessment is profound for choosing appropriated operative approach.3.Infratemporal fossa approach is most common,retrolabyrinthine approach or retrosigmoid approach are united according to the region of tumors.4.Tumors with different pathological type can have specificity in imaging features,which can be used to differential diagnosis.5.Malignant pathological pattern,involvement of facial nerve or later cranial nerve and incomplete resection are possible risk factors of postoperative recurrence and unfavourable prognosis.