gms | German Medical Science

Objective: Jugular foramen tumors are rare challenging lesions for skull base surgeons due to the difficult operative accessibility. Various surgical approaches to the jugular foramen were intradural to overcome the morbidity of standard petrosectomy. In this study we describe a novel navigated tailored presigmoidal, suprabulbar infralabyrinthine approach to the jugular foramen without opening the fallopian canal.

Methods: In this study, eight cadaver heads were dissected under navigational guidance on both sides for the presigmoidal, suprabulbar infralabyrinthine approach without opening the fallopian canal. The cadaver head was fixed in a Mayfield clamp and a C-shaped skin incision was performed. Mastoidectomy was performed using a high-speed drill. Under navigation the sigmoid sinus, jugular bulb, posterior semicircular canal and the fallopian canal were located and preserved. Finally the jugular foramen with the extradural part of the IX, X and XI nerve could be identified by mobilizing down the jugular bulb.

Results: Measurements of the surgical corridor and exposed petrous bone area on high resolution computed tomography showed that the navigated presigmoidal, suprabulbar infralabyrinthine approach without opening the fallopian canal is an appropiated approach for extradural jugular foramen lesions with limited extension. The approach was also used in patients with petroclival tumors without additional morbidity.

Conclusions: The navigation-guided presigmoidal, suprabulbar infralabyrinthine approach is a minimal invasive and safe approach for selected lesions of the jugular foramen with preservation of the fallopian canal, labyrinth block and sigmoid sinus.