Jugular Foramen Meningioma with Transverse and Sigmoid Sinuses Invasion and Jugular Vein Extension

Introduction: Meningiomas of the jugular foramen are extremely rare, and represent ∼0.7 to 4% of all posterior fossa meningiomas and 10% of all intrajugular tumors. We present the case of a jugular foramen meningioma with predominantly intraluminal invasion of the transverse, sigmoid sinuses, jugular bulb and internal jugular vein with venous occlusion. History and Examination: A 45-year-old woman presented a 4-month history of right tinnitus, hearing loss, and dizziness with otherwise a normal neurological exam. MR imaging, positron emission tomography computing of the brain, and conventional angiography were performed preoperatively and revealed a right-sided, extra-axial dural-based mass in the jugular foramen. The lesion filled the distal transverse sinus, the sigmoid sinus and the jugular bulb, extending to the internal jugular vein (Fig. 1). The surgical approach was a high cervical approach with exposure of internal carotid artery, jugular vein, and cranial nerves IX to XII as well as a combined posterior temporobasal and retrosigmoid craniotomy with mastoidectomy and posterior retrolabyrinthine petrosectomy. The transverse, sigmoid sinuses, jugular bulb and superior internal jugular vein were removed en bloc and the exophytic intradural tumor extension around cranial nerves IX, X, XI, and XII was resected subtotally (Fig. 2). The tumor was classified as a WHO grade I transitional meningioma. Postoperatively, the patient presented a transient right facial weakness (House and Brackmann II). MR imaging showed partial resection (Fig. 3). She was discharged home in good condition on the 11th postoperative day. Conclusion: In such particular cases, surgical planning should consider the unusual growth pattern of this type of meningioma, which had predominantly invaded the intraluminal venous compartment, and which exhibited minimal intradural extension only. The resection of tumor together with the occluded sinus/es can be performed safely.

Preoperative pictures

Fig. 1 T: Transverse sinus; S: Sigmoid sinus; J: Jugular bulb; TD: Temporal dura; PFD: Posterior fossa dura.

Fig. 2 T: Transverse sinus; JV: Jugular vein; XI: XI cranial nerve.

Fig. 3 T: Transverse sinus; SS: Sigmoid sinus; CB: Cerebellum.

Fig. 4 Preoperative MRI: Jugular foramen meningioma with predominantly intraluminal invasion of the transverse, sigmoid sinuses, jugular bulb and internal jugular vein with venous occlusion.

Fig. 5 Postoperative MRI: The exophytic intradural tumor extension around cranial nerves IX, X, XI, and XII was resected subtotally.