Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil.
Department of Neurosurgery, Federal University of Paraná, Curitiba, Paraná, Brazil.
Oper Neurosurg (Hagerstown). 2023 Dec 1;25(6):e361-e362. doi: 10.1227/ons.0000000000000775. Epub 2023 Jun 23.
This approach is intended for tumors centered in the jugular foramen with extensions between intracranial and extracranial spaces, possible spread to the middle ear, and variable bony destruction. 1,2.
Jugular foramen paragangliomas are complex lesions that usually invade and fill related venous structures. They present complex relationships with skull base neurovascular structures as internal carotid artery, lower cranial nerves (CNs), middle ear, and mastoid segment of facial nerve. In this way, it is essential to perform an adequate preoperative vascular study to evaluate sinus patency and the tumor blood supply, besides a computed tomography scan to depict bone erosion.
Mastoidectomy through an infralabyrinthine route up to open the lateral border of jugular foramen, allowing exposure from the sigmoid sinus to internal jugular vein. Skeletonization of facial canal without exposure of facial nerve is performed and opening of facial recess to give access to the middle ear in way of a fallopian bridge technique. 2-10.
PITFALLS/AVOIDANCE OF COMPLICATIONS: If there is preoperative preservation of lower CN function, it is important to not remove the anteromedial wall of the internal jugular vein and jugular bulb. In addition, facial nerve should be exposed just in case of preoperative facial palsy to decompress or reconstruct the nerve.
Variations are related mainly with temporal bone drilling depending on the extensions of the lesion, its source of blood supply, and preoperative preservation of CN function.Informed consent was obtained from the patient for the procedure and publication of his image.Anatomy images were used with permission from:• Ceccato GHW, Candido DNC, and Borba LAB. Infratemporal fossa approach to the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.• Ceccato GHW, Candido DNC, de Oliveira JG, and Borba LAB. Microsurgical Anatomy of the Jugular Foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.
本方法适用于颈静脉孔中央的肿瘤，肿瘤延伸至颅内外间隙，可能扩散至中耳，并有不同程度的骨质破坏。1,2.
术前规划和评估的必要条件：颈静脉孔副神经节瘤是一种复杂的病变，通常会侵犯和填充相关的静脉结构。它们与颅底神经血管结构（如颈内动脉、颅神经（CN）、中耳和面神经的乳突段）之间存在复杂的关系。因此，进行充分的术前血管研究以评估窦腔通畅性和肿瘤血供，以及进行 CT 扫描以描绘骨侵蚀是非常重要的。
通过迷路后入路进行乳突切除术，直至打开颈静脉孔的外侧缘，使乙状窦至颈内静脉得以暴露。对面神经管进行骨骼化而不暴露面神经，并打开面神经隐窝，以便采用迷路桥技术进入中耳。2-10.
手术难点/并发症预防：如果术前颅神经（CN）功能得以保留，重要的是不要切除颈内静脉前内侧壁和颈静脉球。此外，如果术前存在面瘫，面神经应暴露出来以减压或重建神经。
变异主要与颞骨钻孔有关，取决于病变的延伸、其血供来源以及术前颅神经（CN）功能的保留情况。患者已对该手术和图像发表知情同意。解剖图像获得了 GHW Ceccato、DNC Candido 和 LAB Borba 的许可。
颈静脉孔区肿瘤的手术治疗[J]. 中华神经外科杂志, 2003, 19(3):214-217.
颈静脉孔区肿瘤的手术治疗[J]. 中华神经外科杂志, 2003, 19(3):214-217.
