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

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