Extradural Transjugular Transsigmoid Approach with High Cervical Exposure for Glomus Jugulare Tumor

Ken Matsushima; Michihiro Kohno; Takao Hashimoto; Hitoshi Izawa; Yujiro Tanaka; Taro Inagaki

doi:10.1055/s-0039-1695057

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 04): S382-S384
DOI: 10.1055/s-0039-1695057

Skull Base: Operative Videos

Georg Thieme Verlag KG Stuttgart · New York

Extradural Transjugular Transsigmoid Approach with High Cervical Exposure for Glomus Jugulare Tumor

Authors

Ken Matsushima

¹ Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
Michihiro Kohno

¹ Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
Takao Hashimoto

¹ Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
Hitoshi Izawa

¹ Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
Yujiro Tanaka

¹ Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
Taro Inagaki

² Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan

Abstract

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Keywords

head and neck - infralabyrinthine approach - infratemporal fossa - jugulotympanic paraganglioma - postauricular transtemporal

Fig. 1 Preoperative post-gadolinium T1-weighted MRIs show a left glomus jugulare tumor extending extracranially (A and B). The tumor was highly vascularized by the stylomastoid, ascending pharyngeal, and posterior auricular arteries (C), and preoperative embolization significantly decreased the tumor staining (D). Postoperative MRIs confirmed successful resection through the transjugular transsigomid approach (E and F).

Fig. 2 (A) The left mastoid bone was exposed and small suboccipital craniectomy was performed. (B) To continuously assess the neural condition in real-time without disturbing the microsurgical procedure, the evoked facial electromyogram was monitored with electrical stimulation at a frequency of 1 Hz throughout the procedure, with a ball-type stimulating electrod placed in the aditus. (C) The intrajugular tumor was dissected, while preserving the anterior wall of the jugular bulb. Venous flow from the inferior petrosal sinus was encountered, and the hemorrhage was promptly controlled using fibrin glue-soaked hemostatic material. (D) The intrapetrous tumor was resected through the corridor above and below the fallopian bridge, while preserving the facial nerve and semicircular canals. The intrajugular and extracranial tumors were also resected after ligation of the internal jugular vein. In this patient, in which the tumor did not invade intradurally and the sigmoid sinus was already occluded preoperatively, the sinus was managed only by coagulation, to avoid unnecessary dural opening and the risk of cerebrospinal fluid leakage. Ant., anterior; C., canal; CN, cranial nerve; Inf., inferior; Int., internal; Jug., jugular; Pet., petrosal; Semicirc., semicircular; Sig., sigmoid; Suboccip., suboccipital; V., vein.

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References

References
1 Liu JK, Sameshima T, Gottfried ON, Couldwell WT, Fukushima T. The combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach for resection of glomus jugulare tumors. Neurosurgery 2006; 59 (01) (Suppl. 01) ONS115-ONS125 , discussion ONS115–ONS125
2 Mann WJ, Amedee RG, Gilsbach J, Perneczky A, Wolfensberger M. Transsigmoid approach for tumors of the jugular foramen. Skull Base Surg 1991; 1 (03) 137-141

Figures

Fig. 1 Preoperative post-gadolinium T1-weighted MRIs show a left glomus jugulare tumor extending extracranially (A and B). The tumor was highly vascularized by the stylomastoid, ascending pharyngeal, and posterior auricular arteries (C), and preoperative embolization significantly decreased the tumor staining (D). Postoperative MRIs confirmed successful resection through the transjugular transsigomid approach (E and F).

Fig. 2 (A) The left mastoid bone was exposed and small suboccipital craniectomy was performed. (B) To continuously assess the neural condition in real-time without disturbing the microsurgical procedure, the evoked facial electromyogram was monitored with electrical stimulation at a frequency of 1 Hz throughout the procedure, with a ball-type stimulating electrod placed in the aditus. (C) The intrajugular tumor was dissected, while preserving the anterior wall of the jugular bulb. Venous flow from the inferior petrosal sinus was encountered, and the hemorrhage was promptly controlled using fibrin glue-soaked hemostatic material. (D) The intrapetrous tumor was resected through the corridor above and below the fallopian bridge, while preserving the facial nerve and semicircular canals. The intrajugular and extracranial tumors were also resected after ligation of the internal jugular vein. In this patient, in which the tumor did not invade intradurally and the sigmoid sinus was already occluded preoperatively, the sinus was managed only by coagulation, to avoid unnecessary dural opening and the risk of cerebrospinal fluid leakage. Ant., anterior; C., canal; CN, cranial nerve; Inf., inferior; Int., internal; Jug., jugular; Pet., petrosal; Semicirc., semicircular; Sig., sigmoid; Suboccip., suboccipital; V., vein.