Pure endoscopic presigmoid infralabyrinthine approach for jugular foramen tumors: Operative technique and early results

Abstract

Background

Jugular foramen (JF) tumors are uncommon, often requiring surgical resection due to their complex anatomical location and varied growth patterns, particularly when intraosseous.

Objective

We propose the pure endoscopic presigmoid infralabyrinthine approach (EPSIL) as a minimally invasive technique for lateral JF access during tumor resection, circumventing the need for extensive exposure of vital structures and jugular vein sacrifice.

Methods

A retrospective analysis was conducted on six patients who underwent EPSIL for JF tumor resection since 2020. The focus was on operative techniques, extent of tumor removal, neurological outcomes, and approach-related morbidity.

Results

The cohort included six patients (three male, three female) with an average age of 46.9 years and a follow-up of 21.6 months. Tumor types were four schwannomas, one paraganglioma, and one chondrosarcoma (WHO grade 2), with average dimensions of 41.2 × 18.8 × 34.5 mm. All were successfully removed via EPSIL, aided by neuro-navigation and monitoring. Four achieved gross-total resections, two subtotal (>90 %), with the latter treated with Gamma Knife for remnants. No tumor recurrence or growth was noted. Preoperative symptoms improved postoperatively, with temporary hoarseness and slight hearing impairment resolving within 8 weeks. One patient had a cerebrospinal fluid leak, managed with a lumbar drain, without long-term deficits.

Conclusion

The EPSIL approach is a highly effective method for the removal of JF tumors, particularly those with intraosseous growth. It stands out as a minimally invasive procedure that harmoniously integrates radical tumor resection with the preservation of cranial nerves.