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The combined transmastoid transjugular transtubercular high cervical approach for resection of jugular foramen tumors

Authors
 Jung Yong Ahn  ;  Yu Shik Shim  ;  Jong Hee Chang  ;  Kyu Sung Lee 
Citation
 Journal of Korean Skull Base Society (대한두개저외과학회지), Vol.3(1) : 26-30, 2008 
Journal Title
 Journal of Korean Skull Base Society (대한두개저외과학회지) 
Issue Date
2008
MeSH
Carotid Artery, Internal/anatomy & histology ; Carotid Artery, Internal/surgery ; Cervical Atlas/anatomy & histology ; Cervical Atlas/surgery ; Craniotomy/methods* ; Facial Nerve Injuries/etiology ; Facial Nerve Injuries/physiopathology ; Facial Nerve Injuries/prevention & control ; Glomus Jugulare Tumor/physiopathology ; Glomus Jugulare Tumor/surgery* ; Humans ; Intraoperative Complications/etiology ; Intraoperative Complications/physiopathology ; Intraoperative Complications/prevention & control ; Jugular Veins/anatomy & histology ; Jugular Veins/pathology ; Jugular Veins/surgery* ; Microsurgery/methods ; Occipital Bone/anatomy & histology ; Occipital Bone/surgery* ; Petrous Bone/anatomy & histology ; Petrous Bone/surgery* ; Skull Base Neoplasms/physiopathology ; Skull Base Neoplasms/surgery*
Keywords
Cranial base approach ; Glomus jugulare tumor ; Jugular foramen exposure ; Microsurgical anatomy
Abstract
Objective : Deep location, hypervascularization, involvement of cranial nerves and vessels, and large extension within the posterior fossa are the main difficulties for surgical resection of the jugular foramen tumors. We describe a combined transmastoid transjugular transtubercular high cervical approach for radical resection of these tumors. Methods : Six patients with jugular foramen tumors were surgically treated using combined transmastoid transjugular transtubercular high cervical approach between January 2000 and June 2008. The complex approach for total jugular foramen exposure can be simplified in a stepwise fashion: 1) postauricular infratemporal incision; 2) retrolabyrinthine mastoidectomy; 3) high cervical exposure; 4) Lateral suboccipital craniotomy and transtubercular exposure; 5) removal of the internal jugular vein (IJV), jugular bulb, and sigmoid sinus; and 6) intradural exposure. Results : Gross total resection was achieved in 5 patients and subtotal resection in one patient. The histologic examination of the tumors revealed as follows: schwannoma (3 cases), meningioma (1 case), paraganglioma (1 case), and chondrosarcoma (1 case). The most frequent complication was a new deficit of lower cranial nerves. There were no facial nerve injury or cerebrospinal fluid leakage. Conclusions : The combined transmastoid transjugular transtubercular high cervical approach described above allows for single-staged radical resection of large complex jugular foramen tumors. This approach has the advantage of providing total exposure of the jugular foramen with multidirectional angles of attack without facial nerve transposition
DOI
10.1227/01.NEU.0000220025.81500.8D
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Shim, Yu Shik(심유식)
Ahn, Jung Yong(안정용)
Lee, Kyu Sung(이규성)
Chang, Jong Hee(장종희)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107235
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