Jugular fossa masses

Jugular fossa masses comprise a range of various pathologies thatpathological lesions that arise in the complex group structures that comprisefrom or extend into the jugular fossa in the skull base. Although it is not a common location for tumours it is not unusual for jugular fossa lesions to be discovered incidentally on cross sectional imaging.

Terminology

Although the jugular foramen is technically an anatomically distinct entity which connects the jugular fossa to the posterior fossa, both contain the same neurovascular structures and lesions here present similarly. As the differential for lesions arising here are the same, for the purposes of this article the terms jugular fossa and jugular foramen will be used interchangeably.

Clinical Features

Although the exact underlying pathology varies most jugular fossa tumours are slow growing and can cause symptoms by compressing the nerves that lie within the fossa. Symptoms can include:

• loss of taste posterior two thirds of the tongue
  • glossopharyngeal nerve palsy (Cn IX)
• vocal cord paralysis and absent gag reflex
  • vagus nerve palsy (Cn X)
• weakness of the trapaezius and stapedius muscles
  • accessory nerve palsy (Cn XI)

When there is unilateral palsy of the 9^th-11^th cranial nerves this is termed as jugular foramen syndrome. 

However, the most common symptoms tend to arise from expansion into the middle ear:

• conductive hearing loss
• pulsatile tinitis (due to tumour vascularity)

Involvement of the inner ear can lead to vertigo and sensorineural hearing loss.

Symptoms of raised intracranial compression can develop if there is significant intracranial extension of the underlying tumour. 

Pathology

The most common lesion seen involving the jugular fossa is aglomus jugulare paraganglioma followed by schwannomas and meningiomas.²

However, jugularJugular fossa masses are broadlycan broadly be classified based as extrinsic or intrinsic. InstrinsicOccasionally, pseudotumours can arise as a result of:

• CSF leak due to trauma
• jugular bulb flow variation

Intrinsic

Intrinsic masses arise from the the structures that traverse the fossa itself while extrinsic masses arises from surrounding tissues and extend into thejugular fossa.

• intrinsic masses
  • paragangliomas
  • schwannoma
  • meningiomas
  • primitive neuroectodermal tumour
• extrinsic

  Extrinsic

  Extrinsic masses

  arise from the surrounding tissues around the jugular fossa and extend into it.
  • ​meningiomas
  • glial cell tumours
  • chordomas
  • chondrosarcomas
  • inflammatory lesions
  • rhabdomyosarcoma
  • temporal bone tumours
  • primary cholesteatoma
  • epidermoid tumours
  • choroid plexus papilloma
• pseudotumours
  • CSF leak due to trauma

  • Radiographic features

    While contrast MRI better at defining the nature of jugular bulb flow variation