Skull Base Metastasis of an Adenocarcinoma Presenting with Jugular Foramen Syndrome

Introduction:Advances in diagnosis and treatment of systemic malignencies in recent years, has led to an increasein the incidence of CNS metastases. Metastatic involvement of the skull base may be seen in 4% of patients with systemic malignencies. Among these, breast, lung and prostate malignencies tend to involve cranial base more often but the primary site of the malignancy can not be detected in 15% of patients. In this report we describe an adenocarcinoma metastasis to the skull base presenting with jugular foramen syndrome.

Material and Method :A 50-year-old woman was admitted to our clinic with the complaint of headache espacially behind the right ear. She reported swallowing difficulty and hoarseness as well. On her neurological examination right ninth and 10th cranial nerve paralysis were recorded. Cranial MRI revealed a nonenhancing large right jugular foramen lesion with extensions into the posterior fossa and cervical region. Cranial CT scan revealed osteo- lytic destruction of the right petrous bone extending into the jugular foramen

Results :The tumor was removed gross totally with the retrosigmoid approach.

Conclusions :Intracranial metastases are the most common intracranial tumor and the most frequent presenting symptom of these patients is headache. Cranial base metastasis is the most common cause of jugular foramen syndrome. Greenberg et al reported 36% of all jugular foramen lesions were metastatic in origin. Laigle-Donadey et al reviewed 279 cases of skull base metastases and noted that jugular foramen syndrome was seen in just 3.5% of patients. Although surgery carries the potential risk of cranial nerve deficits, espacially in radio-resistant metastases, good surgical decompression offers better palliation than radiotherapy. Postoperative radiotherapy is used to control the residual disease, where there is subtotal removal. Knowledge of skull-base metastases is important for the clinician because the diagnosis is often difficult, particularly in patients without known cancer.