gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Interdisciplinary treatment of jugular foramen pathologies using a juxtacondylar approach

Meeting Abstract

  • J. Kaminsky - Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
  • W. Maier - Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
  • G. Ridder - Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
  • H. Löwenheim - Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.04-04

DOI: 10.3205/09dgnc130, URN: urn:nbn:de:0183-09dgnc1301

Veröffentlicht: 20. Mai 2009

© 2009 Kaminsky et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Combined intra and extradural lesions at the jugular foramen provide a particular challenge to interdisciplinary surgical therapy. An appropriate approach should contribute for a most radical tumor resection and best functional result. While the pathologies show many variations the juxtacondylar approach can be applied in many cases. It allows for the control of the tumor, the cranial nerves and the sigmoid sinus. It may be extended if necessary. We demonstrate our indications and surgical technique for resections using the juxtacondylar approach on exemplary cases.

Methods: Preoperative diagnostic includes routine MRI imaging, MRI or conventional angiography for identification of arterial supply and sinus involvement and preoperative embolization, if necessary. A high resolution CT-scan is performed for visualization of the bony skull base anatomy. Surgery is performed interdisciplinary with optional neuronavigation assistance. Intraoperative monitoring of cranial nerves is applied. The surgical steps of the approach and tumor resection are demonstrated on 10 cases including carcinoma, glomus tumors, chordoma, chondrosarcoma, neurinoma and meningeoma.

Results: The juxtacondylar approach allows for extradural tumor removal only, with the option for intradural extension, if necessary. In the temporal bone it can be extended to the Fisch Type A approach, for control of the vessels it can also be extended to the neck. In most neurinoma and glomus tumor cases the juxtacondylar approach allows for a radical resection with preservation of cranial nerve functions. In favour of a function preserving clinical result less radical strategies were pursued, especially in meningeoma cases. Instability of the craniocervical junction has not been observed in the demonstrated cases.

Conclusions: The juxtacondylar approach allows a safe and reliable removal of a variety of pathologies in the jugular foramen. It is well suited for an interdisciplinary strategy for a single staged combined removal of extra- and intradural tumors. In comparison to other approaches especially for glomus tumors the facial nerve may be protected without the necessity for rerouting which would be accompanied by facial paresis in most cases.