Clinical Note |

Skull Base Paraganglioma and Intracranial Hypertension

Patrice Tran Ba Huy, MD; Michèle Duet, MD; Mukedaisi Abulizi, MD; Isabelle Crassard, MD; Jean Pierre Guichard, MD; Philippe Herman, MD, PhD
Arch Otolaryngol Head Neck Surg. 2010;136(1):91-94. doi:10.1001/archotol.125.12.1394.
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Paralysis of the seventh or lower cranial nerves is the most common neurologic complication of jugular foramen paragangliomas. It results from the local aggressiveness of these highly vascular tumors, which are located in the vicinity of important neurovascular structures. In contrast, the literature has only rarely reported intracranial hypertension (ICH),1 usually in association with massive posterior cranial fossa invasion.

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Figure 1.

Venography in case 1. Venograms showing the right jugular foramen paraganglioma obstructing the bulb and the internal jugular vein (asterisk) and the narrowing of the middle aspect of the left transverse sinus (arrows).

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Figure 2.

Venography in case 2. Anteroposterior projection from an angioscanner venogram shows the left jugular foramen paraganglioma filling the jugular bulb and interrupting the venous outflow (arrowhead) and the contralateral vagale paraganglioma compressing the jugular bulb and the internal jugular vein (arrow). Note the intense venous drainage through the vertebral system, suggesting a long-standing and progressive obstruction of the venous return.

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Figure 3.

Magnetic resonance imaging in case 2. Axial T1-weighted gadolinium-enhanced and fat suppression magnetic resonance images at 2 different levels showing the left vagale paraganglioma (A) and the right jugular foramen paraganglioma (B).

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Figure 4.

Arteriography in case 3. A, Preoperative lateral view showing the partial interruption of the right transverse sinus by the paraganglioma, the hypoplastic contralateral sinus (arrows), and the marked drainage through the vertebral veins (asterisk). B, Frontal view at 6 months after surgery showing the development of cortical venous collaterals draining directly into the distal left transverse sinus, thus bypassing the severe stenosis of the midtransverse sinus.

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Skull base paraganglioma and intracranial hypertension. Arch Otolaryngol Head Neck Surg 2010;136(1):91-4.