Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors

• Published in: Journal of neurosurgery Vol. 124; no. 4; pp. 1061 - 1067
• Main Authors: Samii, Madjid, Alimohamadi, Maysam, Gerganov, Venelin
• Format: Journal Article
• Language: English
• Published: United States 01-04-2016
• Subjects: Adult; Aged; Cerebrospinal Fluid Leak - therapy; Deglutition Disorders - etiology; Embolization, Therapeutic; Endoscopy - methods; Female; Glomus Jugulare Tumor - surgery; Humans; Male; Middle Aged; Neurilemmoma - surgery; Neurosurgical Procedures - methods; Paraganglioma - surgery; Postoperative Complications - epidemiology; Radiosurgery; Retrospective Studies; Skull Base Neoplasms - surgery; Treatment Outcome; IPS = inferior petrosal sinus; retrosigmoid; surgical technique; endoscope-assisted; jugular foramen; SS = sigmoid sinus; JB = jugular bulb; infralabyrinthine; JF = jugular foramen; CN = cranial nerve; IJV = internal jugular vein
• ISSN: 0022-3085; 1933-0693
• DOI: 10.3171/2015.3.jns142904

Removal of jugular foramen (JF) tumors usually requires extensive skull base approaches and is frequently associated with postoperative morbidities such as lower cranial nerve injury. The endoscope-assisted retrosigmoid infralabyrinthine approach is a relatively new approach to tumors extending into the bony canal of the JF. The authors present their experience with this approach.
The endoscope-assisted retrosigmoid infralabyrinthine approach was used in 7 patients, including 5 with schwannomas and 2 with paragangliomas. The access to the tumor, extent of its removal, postoperative neurological outcome, and approach-related morbidities were evaluated.
Two patients had a history of previous partial tumor removal, and 1 was treated by embolization followed by two courses of Gamma Knife radiosurgery. In this latter patient near-total resection was achieved. Gross-total resection was possible in the remaining 6 patients. Five patients benefited from endoscopic assistance: in 2 patients it showed a tumor remnant after microscopic tumor removal, while in 3 patients it allowed safe removal of the intraforaminal tumor by visualizing the surrounding structures. No permanent neurological deficit was observed after the operation. Two patients presenting with swallowing disturbance had temporary postoperative worsening that improved later. One patient developed CSF leakage that was managed with a lumbar drain.
This study shows that the judicious application of the endoscope-assisted retrosigmoid infralabyrinthine approach is safe and effective for removal of the schwannomas extending into the JF and selected paragangliomas without significant luminal invasion of the sigmoid-jugular system.