Combined Petrosal Approach With Transcochlear Extension for Fisch D Jugular Paraganglioma: A Technical Case Report

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Neuro-oncology

Background:

• Jugular paragangliomas (JPs) pose surgical challenges due to neurovascular involvement.
• Radiosurgery is a common first-line treatment for JPs.
• Surgical advancements enable feasible alternatives for aggressive JPs with intradural extension.

Purpose of the Study:

• To evaluate the efficacy of a combined petrosal approach with transcochlear extension for complex jugular paragangliomas.
• To demonstrate the surgical technique for extensive JPs involving the petrous apex and internal carotid artery.

Main Methods:

• A Fisch Type D JP case with extensive intradural tumor and brainstem compression was treated.
• A combined petrosal approach with transcochlear extension was utilized.
• Surgical steps and neurovascular structures were documented via video.

Main Results:

• The combined petrosal approach with transcochlear extension provided anteromedial and supratentorial access.
• This approach facilitated management of tumors with extensive intradural and transtentorial extension.
• The surgical technique was effective for a complex jugular paraganglioma case.

Conclusions:

• The combined petrosal approach with transcochlear extension is effective for large JPs invading the petrous apex and internal carotid artery.
• This complex procedure requires expertise in temporal bone anatomy and multidisciplinary teams.
• It is a viable option for JPs not amenable to upfront radiosurgery.