Cranial Nerve Function Preservation in Surgical Resection of Tumors with Jugular Foramen Extension: A Systematic Review

Introduction: The jugular foramen is an area of anatomical complexity and represents a surgical challenge with potential complications related to cranial nerve or vascular injury. Lesions involving this region can produce varied cranial nerve (CN) symptomatology based on their extension through the temporal bone, intracranial compartment, and neck. Nonetheless, approach selection must aim for anatomical and functional preservation of uninvolved nerves. The infratemporal fossa type A approach was the first to allow access to the jugular foramen. Morbidity related to facial and vestibulocochlear nerve dysfunction urged the development of new approaches. These novel techniques along with other intraoperative practices such as nerve monitoring have favored functional preservation.

Materials and Methods: A literature search was conducted in PubMed, Cochrane, Google Scholar, and Embase using the terms “jugular foramen” and “surgery” and “nerve function.” Inclusion criteria were the following: (1) presents history of lesion involving the jugular foramen, (2) surgical resection was the primary treatment, (3) includes description of CN function pre- and postoperatively, and (4) includes description of the surgical approach. The initial search provided 423 articles, from which 26 were ultimately included after duplicate, abstract, and full-text analysis. Demographic data, tumor histology, individual cranial nerve function, surgical details, and postoperative outcomes were collected for further analysis.

Results: A total of 265 patients were included in this review, with a female preponderance (n = 155, 58.5%) and a mean age of 44.3 (13.5) years. Schwannoma was the most commonly reported pathology, followed by paraganglioma and meningioma. Gross total resection was achieved in 168 (63.4%) patients, of which Schwannoma and paraganglioma were the most common histologic diagnosis. Transmastoid approaches were the most commonly used for paragangliomas while the petro-occipital transsigmoid approach was more prominent among patients with meningiomas and schwannomas. Gross total resection with lower cranial nerve function preservation was achieved more commonly with the petro-occipital trans-sigmoid approach. Lower cranial nerve function was also preserved in a greater percentage of patients that underwent intraoperative nerve monitoring.

Conclusion: Surgical management of tumors with extension to the jugular foramen require extensive anatomical knowledge and technical expertise. Surgical planning is essential to select the appropriate approach and reduce cranial nerve morbidity. Gross-total-resection is dependent on the lesion’s extension, infiltrative nature, and surgical approach.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025