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BACKGROUND: Surgical removal of jugular foramen (JF) neurinomas remains controversial due to their radicality in relation to periosteal sheath structures.
OBJECTIVE: To clarify the particular meningeal structures of the JF with the aim of helping to eliminate surgical complications of the lower cranial nerves (LCNs).
METHODS: We sectioned 6 JFs and examined histological sections using Masson's trichrome stain. A consecutive series of 25 patients with JF neurinomas was also analyzed, and the MIB-1 index of each excised tumor was determined.
RESULTS: In the JF, meningeal dura disappeared at the nerve entrance, forming a jugular pocket. JF neurinomas were classified into 4 types: subarachnoid (type A by Samii's classification), foraminal (type B), epidural (type C), and epi-subdural (type D). After an average follow-up of 9.2 years, tumors recurred in 9 cases (36%). Type A tumors did not show regrowth, unlike type B tumors, in which all recurred. Radical surgery by modified Fisch approach did not contribute to tumor radicality in types C and D tumors, even in cases where LCN function was sacrificed. In preserved periosteum, postoperative LCN deterioration was decreased. Bivariate correlation analysis revealed that jugular pocket extension, tumor removal, MIB-1 >3%, and reoperation or gamma knife use were significant recurrence factors.
CONCLUSION: For LCN preservation, the periosteal layer covering the cranial nerves must be left intact except in patients with subarachnoid tumor type. To prevent tumor regrowth, postoperative gamma knife treatment is recommended in tumors with an MIB-1 >3%.
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