This 37-year-old woman presented to our institute with left-sided hearing loss and swallowing difficulties. She reported a 2-year history of tinnitus. Magnetic resonance imaging (MRI) demonstrated a large tumor in the left jugular foramen with extensions to the neck, ear and a small intradural extension (Fig. 10.1). This tumor was an ENI tumor type according to our classification. She underwent total tumor removal through a craniocervical approach. The large surgical defect of the skull base (Fig. 10.2) was reconstructed with vascularized flaps. The lower cranial nerves could be dissected from tumor capsule and preserved. Postoperative a nasal enteral tube was placed and it could be removed 2 weeks after surgery. The swallowing deficits improved gradually. Histological diagnosis was paraganglioma.

A 23-year-old woman had complaint of headaches, tinnitus, and progressive swallowing difficulties for 1 year. About 6 months before admission to our institute she started to complain of change in her voice. On admission she was found to have dysfunction of cranial nerves IX, X, and XI. MRI showed a large enhancing tumor (Fig. 10.3) in the right jugular foramen with extensions to the neck (Tumor type EN). The characteristic sign of paragangliomas “salt and pepper” pattern after gadolinium injection can be observed. The main feeders to this tumor came from the ascending pharyngeal artery and were preoperatively embolized (Fig. 10.4). The lesion was radically resected through a craniocervical approach and the postoperative follow-up was uneventful. Histology revealed non-secreting paraganglioma. A postoperative MRI control demonstrated the radical removal of the tumor (Fig. 10.5).

This 48-year-old woman presented since 1 year swallowing deficits and pulsatile tinnitus on the left ear. An MRI examination (Fig. 10.6) disclosed a large enhancing tumor in the left jugular foramen region with extensions to the ear, neck and intradural (ENI tumor) . The tumor could be totally removed through a craniocervical approach with preservation of the lower cranial nerves. Postoperative the patient developed a complete palsy of the cranial nerves IX, X and facial nerve palsy (H&B III). The postoperative MRI showed complete tumor resection (Fig. 10.7). Histological diagnosis was benign paraganglioma. The swallowing difficulties improved progressively with phonoaudiology rehabilitation program and vocal cord medialization. The facial palsy improved to grade I 6 months after surgery.

This 54-year-old woman was operated on a jugular foramen paraganglioma in 2002 in other hospital. Sub-total resection was performed. After surgery she developed palsy of the IX and X cranial nerves. In 2009 she noted again pulsatile tinnitus in the right ear and MRI disclosed regrowth of the tumor (Fig. 10.8). She was referred to our institute for treatment. Preoperative embolization with Onyx was performed (Fig. 10.8). Radical resection of the lesion was possible (Fig. 10.9). The preoperative deficits remained after surgical removal of the lesion and vocal cord medialization with Teflon injection improved the voice.