A 40-year-old man presented with a one-year history of progressive hoarseness and swallowing difficulty. In the previous three months, he also complained of episodic headaches, mild unsteadiness, and decreased hearing on the right. He was a heavy drinker and a smoker but reported no weight loss or fevers. Physical examination findings included a diminished gag reflex, a tongue which was deviated to the right and atrophied, and a decreased shoulder shrug on the right. Basic labs and a chest X-ray were unremarkable. A computed tomography (CT) scan of the brain showed a destructive mass involving the skull base on the right side measuring about 6 x 4 cm (Figure 1). A CT scan of the neck showed a right jugular foramen mass with associated atrophic changes in the right genioglossus muscle (Figure 2).
The patient was taken to the operating room, and a highly vascular, solid tumor in the region of the right jugular foramen which encased cranial nerves IX, X, and XI was resected
