 Dr. Schupak, we've got a 30-year-old man history withheld. There is a mass in the jugular foramen. We're going to hear about some of the clinical syndromes, Verne syndrome, Gilleray syndrome, at our course in New York City at the Beacon Hotel on May 23rd, but what do you think about this lesion? What do you like is the diagnosis, because there is a differential here. Right. And one of the things that when you talk about jugular foramen mass, the first thing I think comes to most people's mind would be a glomus tumor. Yeah, for me too. But you know, I'm not sure that that's going to work on this one. Glomus tumor usually has that salt and pepper, highly vascular. This is kind of a little more smooth and signal, sheet-like. And also, it seems to me like the location, I usually think of the glomus as sort of being up a little bit higher. And I'm kind of wondering a little bit about this. So that's going to be the 9th, 10th, or 11th nerve complexes coming into this lesion. What do you call that? Well, you could call this, and what it looks to me like is the, remember the tether ball sign? Sure, yeah. I used to play tether ball in summer camp. Because the other thing in the differential is a schwannoma. Those are the ones that usually give you the tether ball sign, as I recall. Or neurofibroma. Neurofibroma. So I'm kind of thinking, along those lines, a schwannoma less likely glomus. I like your idea, because it certainly is not hypervascular. It doesn't have the salt and pepper flow void look. It even looks like it has a little point to it going down, which may follow the other end of the nerve. And the other thing is the vein, right? Meaning usually a glomus is going to involve the vein. This seems to be more displacing the jugular, don't you think? I do. And, you know, another aspect of it is it is vascular. It doesn't enhance, but it doesn't really jump out at you as vascular as the typical glomus tumor does. Another helpful point in evaluating this lesion is most glomus tumors will give you some erosion of the jugular tubercle. And here is the bone marrow, as well as the dark outline of the cortex of the jugular tubercle, and it's preserved. So schwannoma is definitely a better choice, or neurofibroma is a better choice, neural tumor, for this lesion and the jugular foramen. Now, you can see schwannomas as an isolated phenomenon. You know they are associated with NF2. When you have multiple schwannomas and none of the other signs of NF2, then that is known as schwannomatosis. There's also an entity known as schwannosis, which is Schwann cell proliferation. It's kind of hard to say after a trauma. And then you can also see Schwann cell abnormalities or mixoid neurofibromas in the carny triad or the carny complex, which has some different subtypes to be discussed at our course at the Beacon Hotel. So this is a schwannoma of the jugular foramen. It's a beautiful case. It's smooth. It has the characteristics that we discussed that strongly favors it over any other neoplasm, especially a paraganglioma. All right. And just while we happen to be here, so I usually like to look at the other cranial nerves, especially when we're talking about something that could be a manifestation of a systemic condition like neurofibromatosis, looking at the hypoglossal canal. You can see right here it's separate from the seventh and eighth nerve complexes. So usually when I start looking at cranial nerve lesion, I kind of all try to comment, make myself go through all the other cranial nerves. Nerve by nerve. Nerve by nerve. And include that in the report. Great. That's helpful. All right. We'll see you in New York City at the Beacon Hotel on May 23rd, where we'll be discussing cases just like this one. Thanks. Have a great day.