Department of Otolaryngology, Wake Forest Baptist Health, Winston-Salem, NC 27103, USA.
Am J Otolaryngol. 2012 May-Jun;33(3):370-4. doi: 10.1016/j.amjoto.2011.10.006. Epub 2011 Dec 6.
Jugular foramen lesions are often associated with pathology of adjacent structures due to either compression or direct invasion. Common presenting symptoms include pulsatile tinnitus, a neck mass, hearing loss, and cranial nerve palsies, leading to changes in taste, vocal cord paralysis, dysphagia, and sternocleidomastoid/trapezius weakness (A. Hakuba, K. Hashi, K. Fujitani, et al., Jugular foramen neurinomas. Surg Neurol 1979; 11:83-94). This patient was found to have a jugular foramen mass after presenting with the unusual constellation of visual changes and headache.
A jugular foramen mass in a young woman was discovered after presenting with visual changes and headache; the patient was found to have papilledema on initial examination. Otologic and head and neck examination were normal. Subsequent imaging demonstrated a mass at the right jugular foramen with compression of this structure; a contralateral transverse sinus stenosis was also seen. This latter abnormality (along with obstruction of the jugular foramen) impeded venous drainage leading to papilledema and visual changes.
In a patient presenting with papilledema and severe headache with an associated jugular foramen mass, a multidisciplinary approach benefits the patient with input from interventional neuroradiology, neurosurgery, and neuro-ophthalmology. Venous outflow was compromised through the left stenotic transverse sinus, and the normal outflow on the right side through the jugular bulb was impeded by the tumor; obstructions of both led to symptomatic impeded venous outflow. This compromise in venous outflow led to an increase in superior sagittal sinus pressure, with subsequent increase in intracranial pressure and resultant papilledema. In an attempt to increase blood flow, an angioplasty was performed on the patient's affected transverse sinus. In addition, symptomatology consistent with pseudotumor cerebri prompted the use of acetazolamide for medical management. After both therapies, the patient's symptoms dramatically improved and were stable. The tumor has also remained stable, with no immediate need for surgical resection, stereotactic radiation, or consideration of an intraluminal transverse sinus stent placement or shunting.
The unique presentation of a jugular foramen mass in a young woman leading to papilledema highlights the need for high clinical suspicion of potential etiologies necessary for diagnosis. Despite the benign nature of her disease process, an unusual constellation of anatomical factors lead to the need for acute intervention.
由于压迫或直接侵犯，颈静脉孔病变常与邻近结构的病变有关。常见的表现症状包括搏动性耳鸣、颈部肿块、听力损失和颅神经麻痹，导致味觉改变、声带瘫痪、吞咽困难和胸锁乳突肌/斜方肌无力（A. Hakuba、K. Hashi、K. Fujitani 等人，颈静脉孔神经瘤。神经外科学 1979 年；11:83-94）。这位患者在出现不寻常的视觉变化和头痛后，发现颈静脉孔有肿块。
一位年轻女性出现视觉变化和头痛后，发现颈静脉孔有肿块；初次检查发现患者有视乳头水肿。耳科学和头颈部检查正常。随后的影像学检查显示右侧颈静脉孔有肿块，该结构受压；还发现对侧横窦狭窄。后者的异常（以及颈静脉孔阻塞）阻碍了静脉引流，导致视乳头水肿和视觉变化。
在出现视乳头水肿和严重头痛伴颈静脉孔肿块的患者中，多学科方法有益于患者，包括介入神经放射学、神经外科和神经眼科的参与。左侧狭窄的横窦导致静脉流出受阻，右侧正常的颈静脉球流出也因肿瘤而受阻；两者的阻塞导致静脉流出受阻。这种静脉流出受阻导致上矢状窦压力增加，继而颅内压升高，导致视乳头水肿。为了增加血流量，对患者受影响的横窦进行了血管成形术。此外，由于假性脑瘤的症状，患者还使用乙酰唑胺进行了药物治疗。在这两种治疗方法后，患者的症状明显改善且稳定。肿瘤也保持稳定，目前无需手术切除、立体定向放疗，或考虑放置或分流横窦内支架。
年轻女性颈静脉孔肿块引起视乳头水肿的独特表现强调了对潜在病因进行高度临床怀疑的必要性，以便做出诊断。尽管她的疾病过程是良性的，但不寻常的解剖因素组合导致需要进行急性干预。
