Roche P-H, Moriyama T, Thomassin J-M, Pellet W
Service de Neurochirurgie, Centre Hospitalier Sainte Marguerite, Marseille, France.
Acta Neurochir (Wien). 2006 Apr;148(4):415-20. doi: 10.1007/s00701-006-0741-5. Epub 2006 Feb 17.
Evidence of a high jugular bulb position (HJBP) during the translabyrinthine approach may compromise the surgical removal of cerebellopontine angle (CPA) tumours. We report a simple surgical procedure to safely manage this frequent normal variation and comment on various alternative options.
The translabyrinthine approach included a complete skeletonization of the sigmoid sinus and of the presigmoid dura. A thin eggshell bone was left at the jugular bulb surface. The dome of the jugular bulb was gently dissected from the jugular fossa and gradually retracted downward in a tailored way, allowing the surgeon to drill below the internal auditory meatus. A small piece of bone was wedged over the jugular dome in order to maintain its lowered position.
Among 178 consecutive translabyrinthine approaches performed for the removal of large CPA tumors, the use of this procedure was required in 44 cases of HJBP. Excepting minimal venous bleeding easily controlled in several cases, we never observed any complication from this procedure nor failure to expose the inferior compartment of the CPA.
The HJBP can be systematically diagnosed with the preoperative CT-scan using bone window imaging. Our results demonstrate that the described procedure is safe and effective to widen the operative corridor that is required for the exposure of the inferior compartment of the CPA in this anatomical situation.
经迷路入路时高位颈静脉球（HJBP）的证据可能会影响桥小脑角（CPA）肿瘤的手术切除。我们报告一种简单的手术方法来安全处理这种常见的正常变异，并对各种替代方案进行评论。
经迷路入路包括乙状窦和乙状窦前硬脑膜的完全骨骼化。在颈静脉球表面留下一层薄的蛋壳样骨质。将颈静脉球的圆顶从颈静脉窝轻轻分离，并以定制的方式逐渐向下牵拉，使外科医生能够在内耳道下方钻孔。在颈静脉球圆顶上楔入一小片骨质以维持其降低的位置。
在连续178例为切除大型CPA肿瘤而进行的经迷路入路手术中，44例HJBP病例需要采用此手术方法。除了在少数病例中容易控制的少量静脉出血外，我们从未观察到该手术方法有任何并发症，也未出现无法暴露CPA下间隙的情况。
使用骨窗成像的术前CT扫描可系统诊断HJBP。我们的结果表明，所述手术方法对于在这种解剖情况下扩大暴露CPA下间隙所需的手术通道是安全有效的。
