Retrosigmoid Intradural Suprajugular Approach to Jugular Foramen Tumors with Intraforaminal Extension: Surgical Series of 19 Cases

Abstract

The intraforaminal component of jugular foramen tumors is difficult to access surgically, as it requires complex approaches for radical removal and leads to a high recurrence due to residual tumor. The retrosigmoid suprajugular approach, intradural drilling of the roof of the jugular foramen, has been recently proposed for removal of such intraforaminal component without sacrificing the sigmoid-jugular venous system or requiring additional approaches. This study presents our experience with this approach and introduces the use of intraoperative continuous vagus nerve monitoring. Nineteen patients (14 with neuromas and 5 with meningiomas) were operated using this approach over a 12.5-year period. In the more recent 14 cases, continuous vagus nerve monitoring was performed with a ball-type electrode placed on the proximal vagus nerve. More than 95% of the tumor removal was achieved in all but the first neuroma case. Extubation immediately after surgery and oral feeding within a week postoperatively was achieved in all patients. Seven of 9 patients with preoperative hearing disturbance symptomatically improved after surgery. All but the first case had no signs of recurrence during the follow-up period (average of 58 months). The retrosigmoid suprajugular approach is safe and effective for removal of tumors extending into the jugular foramen, maintaining a chance of hearing improvement. Intraoperative continuous vagus nerve monitoring is useful to avoid postoperative complications in such surgeries.