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