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Clinical Analysis with Imaging Features in Nasophayngeal Carcinoma with Jugular Foramen Involvement

HUANG Sheng-fu, ZHANG Lan-fang, WEI Bao-qing, et al. (Jiangsu Provincial Cancer Hospital, Nanjing 210009, China)  
[Purpose] To study the clinical and imaging features in nasophayngeal carcinoma (NPC) with jugular foramen involvement and their clinical significance. [Methods] Clinical presentations and imaging features of CT and MRI in 12 NPC patients with jugular foramen involvement (initial treatment, 8 cases; recurrence, 4 cases) were analyzed retrospectively. [Results] Of 12 cases, 5 cases presented with all Ⅸ~Ⅺ cranial nerves palsy (Jugular foramen syndrome), and other 7 cases with only Ⅸ cranial nerve palsy, 10 cases revealed radiologically hypoglossal canal involvement coinstantaneously, 3 cases with atrophy of unilateral sternocleidomastoid and trapezius, 2 cases with unilateral tongue atrophy. CT or MRI showed the major spreading roads to jugular foramen in NPC were as following: ①primary lesions invaded through poststyloid space directly (4 cases in this way,including 1 case with poststyloid space recurrence); ②lymph node metastasis (4 cases, 2 of them were retropharyngeal lymph node and 2 recurrent carotid sheath node);③bony structure damage as a result of the extension of skull base invasion (4 cases, including 1 case with jugular foramen recurrence alone). [Conclusion] NPC may spread to jugular foramen by direct extension from primary lesion,or by retropharyngeal and carotid sheath node extension, or by direct bony damage of jugular foramen.When jugular foramen involved,one or more branchs of Ⅸ~Ⅺ cranial nerves's palsy may present as clinical features. CT or/and MRI ,especially MRI play an important role in diagnosis, assessment of lesion extent and radiotherapy planning.
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