A different technique used for the closure of sigmoid sinus during infratemporal approach

Glomus jugulare tumors and neuromas frequently affect the jugular foramen area and necessitate special surgical approaches. It is often essential to stop blood flow by occluding internal jugular vein from below and the sigmoid sinus from above. Obviously, injury to the venous structures without proximal and distal control results serious haemorrhage. We describe here, a different technique for the closure of sigmoid sinus during infratemporal approach and compare it with the other techniques.

During the infratemporal approach, for closing the sigmoid sinus, we removed the bone over the sinus and from the posterior fossa dura located anteriorly and posteriorly to the sigmoid sinus. Then a 2/0 atraumatic silk suture was passed horizontally through dura which is behind and in front of the sinus. A muscle graft was then placed between the suture and sigmoid sinus.

We used that technique in 7 patients who had a glomus jugulare tumor. In that technique, the blood flow was completely stopped without penetrating the sinus.

Sigmoid sinus can be closed without incision of the sinus or the dura. This decreases the chances of injury to the sinus and dura resulting in less bleeding and less chances of CSF leak.