Introduction: Tumors of the jugular foramen are rare and highly vascularized skull base lesions. These deep-seated lesions often involve important neurovascular structures of the lateral skull base. The most popular surgical approaches to access this region are the lateral and postero-lateral approaches, including the presigmoid infralabyrinthine mastoidectomy with cervical dissection and retrosigmoid approach and its more extensive far-lateral and transcondylar variants. Each of these approaches can be combined for cases of extended lesions or combined with a cervical dissection for cases with inferior extracranial extension. We described the three-dimensional anatomy and microsurgical landmarks for the treatment of such lesion of the jugular foramen.
Methods: Using five preserved adult cadaveric heads (10 sides) injected with colored latex, we performed standard and extended retrosigmoid approaches, far lateral approaches with and without condylar and jugular tubercle resection, presigmoid mastoidectomies, as well as different combinations of these approaches together with cervical dissection. We evaluated and compared the areas of exposure provided by each of these approaches taking into account the surgical trajectory, angle of access, and surgical maneuverability.
Results: Our study provided a three-dimensional view of the surgical anatomy of the jugular foramen and the associated anatomical relationships. The presigmoid mastoidectomy used alone or in combination with other approaches, was the preferred route for lesions extending through the jugular foramen. The posterior approaches were best suited to the intracranial intradural portion of the lesion. Cervical dissection addresses lesions extending extracranially. A combination of the approaches can be used to expose lesions which extend in multiple directions.
Conclusions: The lateral surgical approaches when combined with a high cervical dissection provide improved visualization of the extradural region of the jugular foramen and the surrounding neurovascular structures. The posterior approaches in combination with the lateral approaches target the intradural portion of the lesion. The nature and location of the lesion is the main factor when selecting the optimal surgical approach.
Patient Care: By increasing participants knowledge of the associated surgical anatomy.
Learning Objectives: By the conclusion of this session, participants should be able to understand approaches to the jugular foramen