A novel cosmetic vascularized bone flap craniotomy for postauricular transmastoid approach for jugular foramen tumors

Postauricular transmastoid approach is widely used for jugular foramen tumor resection. However, because of bone drilling and muscle detachment, postoperative complication such as suboccipital muscle atrophy, postauricular deformity, and subcutaneous CSF collection occurs occasionally. We propose a novel vascularized bone flap craniotomy for postauricular transmastoid approach, which can minimize the postoperative complications mentioned above and provide wide corridor for jugular foramen tumor.

Adult cadaveric heads were dissected to simulate the vascularized bone flap craniotomy. Key anatomical landmarks were identified, and stepwise surgical technique was developed. Bone flap dimensions, exposure of the sigmoid sinus and jugular foramen, and preservation of the occipital artery supply to the SCM were evaluated. Protective strategies for the sigmoid sinus were emphasized.

The vascularized bone flap (mean dimensions: 4.5 × 3.6 cm) provided wide exposure of the transverse sinus, entire sigmoid sinus, and jugular foramen. The occipital artery branch to the SCM was consistently preserved, confirming vascularization of the bone flap. The technique allowed anatomical reposition of bone and muscle, potentially preventing postoperative deformity and muscle atrophy. Sigmoid sinus injury was avoided by using gelatin sponge protection and precise bone cuts under microscopic guidance.

This vascularized bone flap craniotomy is a safe, reproducible technique that maintains vascular supply and muscular attachments, offering a promising option to improve cosmetic and functional outcomes in jugular foramen tumor surgery.