Presentation
Progressive, persistent binocular diplopia due to a right CN 6 palsy.
Patient Data
There is enlargement and demineralization of the right jugular foramen and adjacent bony structures, with a well defined soft tissue component.
A solid enhancing mass is seen involving the right hypoglossal canal and jugular foramen, adjacent to the right carotid/jugular space, and medially into the clivus. Superiorly, it extends within the bone and into the dura. The dural disease along the dorsum of the clivus has an en plaque appearance, and is in proximity to the right 6th cranial nerve. Given the anatomy of this region, Dorello's canal is also likely involved.
The most inferior extent of the lesion within the jugular/carotid space extends quite far down at least to the level of the C2-3 disc. The erosive changes of the clivus are appreciated more on CT, compared to MRI.
Overall, findings are compatible with jugular paraganglioma.
Case Discussion
The patient underwent presurgical embolization followed by subtotal resection of the lesion and subsequent radiotherapy. Histologically, features were diagnostic of jugular paraganglioma
The case was contributed by Dr Grant Linnel, Associate Professor of Radiology at McGill University.
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