Transjugular craniotomy for the management of jugular foramen tumors with intracranial extension.
OBJECTIVE
To elucidate indications and outcomes with the transjugular craniotomy for resection of jugular foramen tumors with intracranial extension. The transjugular approach is a lateral craniotomy conducted through a partial petrosectomy traversing the jugular fossa combined with resection of the sigmoid sinus and jugular bulb, which often have been occluded by disease.


METHODS
Retrospective review.


METHODS
University medical center.


METHODS
Twenty-eight patients with intracranial jugular foramen tumors who underwent a total of 30 surgical procedures.


METHODS
Pathologic findings, surgical approach, extent of tumor resection, rate of facial nerve mobilization and ear canal closure, facial and lower cranial nerve outcomes, and hearing preservation.


RESULTS
Tumors included schwannoma (37%), meningioma (33%), glomus jugulare (23%), and chordoma (7%). The surgical approaches were tailored to maximize functional preservation, and included the transjugular (53%), translabyrinthine (17%), retrosigmoid (10%), and far lateral (7%) craniotomies. Translabyrinthine (3%) or transcondylarfar lateral (3%) approaches were occasionally used in combination with the trans-jugular approach. Most procedures were managed in a single stage (90%), but three patients with massive tumor in the neck required two stages. Microsurgical gross total and near-total tumor removal (37% each) were commonly achieved, although subtotal resections (27%) were occasionally performed. In only a minority of cases was facial nerve mobilization (7%) or ear canal closure (21%) required. If present preoperatively, Grade I facial nerve function was usually maintained (22 of 24 [92%]) and Hearing Class A or B could always be maintained (9 of 9 [100%]). As expected, new lower cranial nerve dysfunction was common (8 of 30 [27%]), although over half of the patients had complete lower nerve palsy preoperatively (16 of 30 [53%]).


CONCLUSIONS
Most patients with jugular foramen tumors with intracranial extension can be managed with a single-stage transjugular craniotomy. Facial nerve mobilization or ear canal closure is usually not required, permitting conservation of facial function and hearing, when present preoperatively.
Oghalai
John S
JS
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA. jso@bcm.tmc.edu
Leung
Man-Kit
MK
Jackler
Robert K
RK
McDermott
Michael W
MW
D000328:Adult; D000368:Aged; D002648:Child; D002817:Chordoma / Q000473:pathology / Q000601:surgery*; D003389:Cranial Nerve Diseases / Q000209:etiology; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005154:Facial Nerve / Q000502:physiology; D005260:Female; D005925:Glomus Jugulare Tumor / Q000473:pathology / Q000601:surgery*; D034381:Hearing Loss / Q000517:prevention & control; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome