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. 2023 Dec 1;25(6):e361-e362.
doi: 10.1227/ons.0000000000000775. Epub 2023 Jun 23.

Transmastoid/Infralabyrinthine Approach to the Jugular Foramen: 2-Dimensional Operative Video

Guilherme H W Ceccato  1 , Rodrigo S Foltran  1 , Kauê Franke  1 , Matheus P Dias  1 , Mikail Sallé  1 , Luis A B Borba  1   2
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Transmastoid/Infralabyrinthine Approach to the Jugular Foramen: 2-Dimensional Operative Video

Guilherme H W Ceccato et al. Oper Neurosurg. .

Abstract

Indications corridor and limits of exposure: This approach is intended for tumors centered in the jugular foramen with extensions between intracranial and extracranial spaces, possible spread to the middle ear, and variable bony destruction. 1,2.

Anatomic essentials need for preoperative planning and assessment: Jugular foramen paragangliomas are complex lesions that usually invade and fill related venous structures. They present complex relationships with skull base neurovascular structures as internal carotid artery, lower cranial nerves (CNs), middle ear, and mastoid segment of facial nerve. In this way, it is essential to perform an adequate preoperative vascular study to evaluate sinus patency and the tumor blood supply, besides a computed tomography scan to depict bone erosion.

Essential steps of the procedure: Mastoidectomy through an infralabyrinthine route up to open the lateral border of jugular foramen, allowing exposure from the sigmoid sinus to internal jugular vein. Skeletonization of facial canal without exposure of facial nerve is performed and opening of facial recess to give access to the middle ear in way of a fallopian bridge technique. 2-10.

Pitfalls/avoidance of complications: If there is preoperative preservation of lower CN function, it is important to not remove the anteromedial wall of the internal jugular vein and jugular bulb. In addition, facial nerve should be exposed just in case of preoperative facial palsy to decompress or reconstruct the nerve.

Variants and indications for their use: Variations are related mainly with temporal bone drilling depending on the extensions of the lesion, its source of blood supply, and preoperative preservation of CN function.Informed consent was obtained from the patient for the procedure and publication of his image.Anatomy images were used with permission from:• Ceccato GHW, Candido DNC, and Borba LAB. Infratemporal fossa approach to the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.• Ceccato GHW, Candido DNC, de Oliveira JG, and Borba LAB. Microsurgical Anatomy of the Jugular Foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.

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References

    1. Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment and outcome. J Neurosurg. 2002;97(6):1356-1366.
    1. Borba LAB, Araújo JC, de Oliveira JG, et al. Surgical management of glomus jugulare tumors: a proposal for approach selection based on tumor relationships with the facial nerve. J Neurosurg. 2010;112(1):88-98.
    1. Ceccato GHW, Candido DNC, de Oliveira JG, Borba LAB. Infra-temporal fossa approach to the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.
    1. Ceccato GHW, Candido DNC, de Oliveira JG, Borba LAB. Microsurgical Anatomy of the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.
    1. Ceccato GHW, Rassi MS, Borba LAB. Microsurgical resection of multiple giant glomus tumors. J Neurol Surg B Skull Base. 2019;80(s 04):s385-s388.

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