Rerouting Technique of the Facial Nerve in the Procedure of Removal of Jugular Foramen Tumors: Outcomes and Indications
Objective: To analyze retrospectively the functional outcome of the facial nerve after different nerve rerouting techniques in the procedure of removal of jugular foramen tumors (JFT), and to discuss their indications. Methods: From 2004 to 2013, 47 patients with JFT were operated on, in which 40 were totally, 6 near-totally, and 1 partially resected. The pathologies consisted of 35 paragangliomas, 6 schwannomas, 4 chordomas, 1 synovial sarcoma, and 1 ossifying myxoid tumor. Infratemporal fossa type A (IFTA) approach was performed in 23 cases, infratemporal fossa combined translabyrinthine approach in 10 cases, petro-occipital transsigmoid approach (POTS) in 14 cases. Results: The total rerouting of facial nerve was done in 14 cases, partial rerouting in 12 cases, and no rerouting in 21 cases. The facial nerve function after 1 year was HB I-II in 28 cases, HB III-IV in 17 cases, and HB V-VI in 2 cases. Compared with the preoperative facial function, the function of 18 patients deteriorated, 2 improved, and 27 unchanged. Conclusion: The intraoperative facial nerve injury is a common complication in the surgery of JF. The nature, size, location of tumors, preoperative facial function, surgical approach, and intraoperative nerve management could affect the prognosis of facial nerve function. Partial or no rerouting of facial nerve could be used in the procedure of removal of JFT to obtain better facial function. The tumors, those posterior and inferior to the labyrinth, could be removed via IFTA with partial or no rerouting of the facial nerve or POTS.