Jugular fossa masses

Jugular fossa masses comprise a range of pathological lesions that that arise from or extend into thejugular fossa in the skull base. Although it is not a common location for tumours 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 compressing the nerves that lie within within the fossa. Symptoms can include:

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

When there is unilateral palsy of the 9^th-11^th cranial nerves this is termed asjugular 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

Classification

Jugular fossa masses can broadly broadly be classified as extrinsic or intrinsic. Occasionally, pseudotumours can arise as a result of:

• CSF leak due to trauma trauma
• jugular bulb flow variation

Intrinsic

Intrinsic masses arise from the the structures that traverse the jugular fossa.

• paragangliomas
• schwannoma
• meningiomas
• primitive neuroectodermal tumour

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

Radiographic features

While contrast MRI better at defining the the nature of jugular fossa lesions CT is superior in assessing any involvement of the adjacent bony structures.