Partial Resection of Jugular Foramen Tumors: Improved Outcomes with Facial Nerve Protection Using Silicone Sheeting

Background Lesions of the jugular foramen are located deep within the skull base and are in close proximity with important neurovascular structures including the internal carotid artery, facial nerve, and cranial nerves IX and X. In the elderly population, total resection of these lesions exposes patients to the risk of acute paralysis of noncompensated cranial nerves IX and X due to the slow and often incomplete physiologic compensation in this age group. Additionally, this procedure requires a prolonged and extensive operation, which many patients, elderly and/or sick, may not be able to tolerate. However, observation may lead to significant morbidity due to facial nerve paralysis by tumor invasion. The purpose of our study is to determine if partial resection of jugular foramen tumors with facial nerve protection using silicone sheeting is a viable alternative to preserve facial nerve function and reduce morbidity associated with total resection or observation.

Objectives To compare facial nerve outcomes following partial resection of jugular foramen tumors with facial nerve protection versus total resection and observation. To compare any surgical or medical morbidity following partial resection of jugular foramen tumors with facial nerve protection versus total resection. To demonstrate a technique for the partial resection of jugular foramen tumors with facial nerve protection.

Study Design A retrospective chart review of patients who were managed with surgical resection (total resection vs. partial with silicone sheeting) or observation for a jugular foramen lesion from 2001 to 2017 at our tertiary care academic medical center was conducted.

Methods Patients’ records were reviewed and analyzed for age, sex, tumor type, surgery versus observation (± radiation), comorbidities, preoperative and postoperative exam findings (House–Brackmann’s classification), and complications. Further description of the surgical technique used by surgeon (J.P.L.) for partial resection with silicone sheeting will be discussed in this section.

Results Our retrospective review demonstrated that from 2001 to 2017 at our tertiary care academic center, patients were managed with total resection (n = 19), partial resection with silicone sheeting (n = 5), observation (n = 8), and radiation (n = 6). Our preliminary results reveal that partial resection using silicone sheeting was associated with stable or improved facial function after surgery. No surgical morbidity of the lower cranial nerve IX or X was found in the partial resection group. There was no statistically significant difference found in facial nerve function between partial resection with silicone sheeting and total resection groups.

Conclusion Our preliminary results have demonstrated the viability of partial resection of jugular foramen tumors with facial nerve protection using silicone sheeting as an alternative to total resection or observation. Partial resection with silicone sheeting resulted in stable or improved facial nerve outcomes without evidence of acute paresis or paralysis of the lower cranial nerves IX and X. This article also describes the surgical technique used above by surgeon J.P.L., which can be used in patients unable to undergo total resection of jugular foramen tumors, for whom facial nerve preservation remains a priority.