[Surgical management of jugular foramen tumors]

To report the clinical manifestations, imaging characteristics, surgical approaches, managements, and outcome of jugular foramen tumors. The detailed clinical information of this extremely rare tumor was presented, with special emphasis on certain key issues, e. g, the preoperative estimation, perioperative management, surgical skill and experience, which exerted an influence on the significance of total tumor resection and preventing complications.

From 1985 to 2007, 42 patients with jugular foramen tumor (30 cases of jugular paragangliomas and 11 cases of tumor with particular pathological types) were enrolled in this study. Prior to surgical procedures, all patients were subjected to systematic imaging examinations on temporal bone, such as CT, HRCT, CTA, and MRI, and some patients were further examined by angiography or embolization according to the individual situations. The infratemporal type A and combined translabrinthin and/or transchecholea approaches were selected for the treatment of 30 cases of jugular paragangliomas; while, the modalities of infratemporal type A, enlarged mastoidectomy, or mastoid-neck approach were employed for the remaining 11 specific cases.

Forty-two patients in this report were categorized into beyond C types based on FISCH classification in which all had invaded to posterior fossa. In the 31 cases, the major initial clinical symptoms were tinnitus, hearing loss, and facial palsy; while, in the 11 specific cases, the main symptoms did not possess any unique trait for the diagnosis and 5 of which were found via CT or MRI examination by chance. Facial nerve management included permanent anterior transposition (19 cases), facial nerve bridge technology (16 cases), interposition graft (4 cases), VII-XI jump graft (2 cases), and VII-XII anastomosis (1 case).

The preoperative estimation of tumor in nature was of great importance in the determination of proper surgical approaches and the infratemporal type A could fully meet the requirement for resection of tumors in jugular foramen. Facial nerve anterior rerouting could provide a clear visual field during the procedure, especially for the lesions in anterior tympanic cavity. In most cases, the facial nerve bridge technology could also fulfill the needs for complete tumor resection as well as the better preservation of facial function. In case of considering the sacrifice of internal carotid artery, balloon test occlusion was indispensable for preoperative estimation. The CT or MRI characteristics of tumors with particular pathological types were different from those of jugular paragangliomas. The preoperative management, surgical skills, and experience played a pivotal role in complete tumor resection.