The suprabulbar approach for jugular fossa schwannomas: case series and technical nuances

Jugular fossa schwannomas are rare tumors arising from the lower cranial nerves. Their complex anatomical location poses significant surgical challenges. This study presents the authors' experience with the suprabulbar approach, refined through cadaveric dissections, as a safe and effective technique to achieve gross-total resection of jugular fossa schwannomas, while preserving the lower cranial nerves and minimizing the risk of postoperative morbidity.

The suprabulbar step-by-step approach was performed bilaterally on 8 formalin-fixed cadaveric heads, and anatomical measurements were obtained to assess the variability of the presigmoid infralabyrinthine surgical window. A retrospective analysis was conducted of the records of 22 patients with jugular fossa schwannomas who underwent resection between 1994 and 2024. Pre- and postoperative data were reviewed to assess the intraoperative technique and surgical outcomes.

Of 22 tumors, 20 (91%) were classified as type D, while 1 tumor each was classified as type A and type B. Gross-total resection was achieved in 77% of cases. There were no deaths or permanent neurological deficits. Transient lower cranial nerve deficits occurred in 14% of patients, all of which resolved during the follow-up period (mean 31.4 months). One perioperative complication was recorded as a suspected CSF leak. Overall, 64% of patients experienced improvement in preoperative neurological deficits. Three (14%) patients had confirmed tumor recurrence, all of whom underwent successful reoperation.

The suprabulbar approach, guided by meticulous anatomical planning, provides a reliable and versatile route for the resection of jugular fossa schwannomas. It enables fascicle-sparing resection through a safe window in the presigmoid dura, preserving critical structures, including the labyrinth and facial nerve, while facilitating decompression of the jugular bulb. Its versatility lies in the ability to combine intradural access with neck dissection in a single-stage procedure, allowing for maximal tumor removal for large and giant tumors and minimizing cranial nerve morbidity.