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Jugular foramen lesion diagnostic dilemma – schwannoma or paraganglioma: A case report

Sachin Sambhaji Chemate , Joy Varghese, Chandrasekar K, Shankar Ganesh CV, Mangaleswaran Balamurugan

Sachin Sambhaji Chemate
Resident, Department of Neurosurgery, Apollo Hospitals, Chennai. Email: sachin.19chemate@gmail.com

Joy Varghese
Senior Consultant, Department of Neurosurgery, Apollo Hospitals, Chennai

Chandrasekar K
Senior Consultant, Department of Neurosurgery, Apollo Hospitals, Chennai

Shankar Ganesh CV
Senior Consultant, Department of Neurosurgery, Apollo Hospitals, Chennai

Mangaleswaran Balamurugan
Senior Consultant, Department of Neurosurgery, Apollo Hospitals, Chennai
Online First: December 01, 2019 | Cite this Article
Chemate, S., Varghese, J., K, C., Ganesh CV, S., Balamurugan, M. 2019. Jugular foramen lesion diagnostic dilemma – schwannoma or paraganglioma: A case report. Indonesian Journal of Neurosurgery 2(3). DOI:10.15562/ijn.v2i3.51


Introduction: Various anomalies occure in the jugular foramen. The most common lesion within the jugular foramen is the hypervascular glomus jugulare tumour followed by neurogenic tumors, predominantly schwannoma. Jugular foramen schwannoma can also be vascularized and frequently mimics paraganglioma.

Case presentation: We present a case of a 36-year-old woman who presented with 8 to 10 months history of  giddiness and vertigo, slowly progressive sensorineural hearing loss in left ear,  gradually progressive left facial weakness (House Brackman grade III at the time of admission) and gait ataxia. A magnetic resonance imaging showed an avidly enhancing extra axial left cerebello-pontine angle space occupying lesion extending through the jugular foramen into the petrous temporal bone on the left side with prominent central flow voids. Paraganglioma was suspected and Digital Subtraction Angiography was done which showed tumour blush with arteriovenous fistula supplied by stylomastoid artery, which is branch of occipital artery. Surprisingly, histopathology after surgical resection revealed schwannoma.

Conclusion: Prominent central vascularity and arteriovenous fistula with arterial supply from stylomastoid branch of occipital artery can be an unusual presentation for jugular foramen schwannomas. We describe architecture of vascualrity of jugular schwannoma and identify stylomastoid branch of occipital artery as its prime feeder.

Keywords: jugular foramen schwannoma, paraganglioma

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