Samii Madjid, Alimohamadi Maysam, Gerganov Venelin
International Neuroscience Institute, Hannover, Germany; and.
Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
J Neurosurg. 2016 Apr;124(4):1061-7. doi: 10.3171/2015.3.JNS142904. Epub 2015 Oct 2.
Removal of jugular foramen (JF) tumors usually requires extensive skull base approaches and is frequently associated with postoperative morbidities such as lower cranial nerve injury. The endoscope-assisted retrosigmoid infralabyrinthine approach is a relatively new approach to tumors extending into the bony canal of the JF. The authors present their experience with this approach.
The endoscope-assisted retrosigmoid infralabyrinthine approach was used in 7 patients, including 5 with schwannomas and 2 with paragangliomas. The access to the tumor, extent of its removal, postoperative neurological outcome, and approach-related morbidities were evaluated.
Two patients had a history of previous partial tumor removal, and 1 was treated by embolization followed by two courses of Gamma Knife radiosurgery. In this latter patient near-total resection was achieved. Gross-total resection was possible in the remaining 6 patients. Five patients benefited from endoscopic assistance: in 2 patients it showed a tumor remnant after microscopic tumor removal, while in 3 patients it allowed safe removal of the intraforaminal tumor by visualizing the surrounding structures. No permanent neurological deficit was observed after the operation. Two patients presenting with swallowing disturbance had temporary postoperative worsening that improved later. One patient developed CSF leakage that was managed with a lumbar drain.
This study shows that the judicious application of the endoscope-assisted retrosigmoid infralabyrinthine approach is safe and effective for removal of the schwannomas extending into the JF and selected paragangliomas without significant luminal invasion of the sigmoid-jugular system.
切除颈静脉孔（JF）肿瘤通常需要广泛的颅底入路，且常伴有术后并发症，如下颅神经损伤。内镜辅助乙状窦后迷路下入路是一种相对较新的用于切除延伸至JF骨管内肿瘤的入路。作者介绍了他们应用该入路的经验。
7例患者采用内镜辅助乙状窦后迷路下入路，其中5例为神经鞘瘤，2例为副神经节瘤。评估肿瘤的暴露情况、切除范围、术后神经功能结果及与入路相关的并发症。
2例患者曾有部分肿瘤切除史，1例先接受栓塞治疗，随后进行了两个疗程的伽玛刀放射治疗。在后一例患者中实现了近全切除。其余6例患者实现了全切除。5例患者得益于内镜辅助：2例患者在显微镜下切除肿瘤后，内镜显示有肿瘤残留；3例患者通过观察周围结构，得以安全切除孔内肿瘤。术后未观察到永久性神经功能缺损。2例出现吞咽障碍的患者术后有短暂加重，随后好转。1例患者发生脑脊液漏，通过腰大池引流处理。
本研究表明，对于切除延伸至JF的神经鞘瘤和部分无乙状窦 - 颈静脉系统明显管腔内侵犯的副神经节瘤，明智地应用内镜辅助乙状窦后迷路下入路是安全有效的。
