[The surgical outcomes in management of jugular foramen paragangliomas with tension free anterior rerouting of the facial never and tunnel packing of the inferior petrous sinus].

The aim of this study is to evaluate the safety and efficacy of surgical interventions ofjugular foramen paragangliomas（JFP） utilizing modified surgical techniques, tensionfree anterior rerouting of the facial nerve and tunnel-packing or push-packing of the inferior petrous sinus. A retrospective analysis was conducted on a cohort of 88 patients diagnosed with JFP and treated at the Eye Ear Nose and Throat Hospital of Fudan University（in Shanghai, China） from October 2010 to June 2021. The surgical outcomes were analyzed for tumor classification, intraoperative conditions, and function of the postoperative facial nerve（FN） and lower cranial nerve（LCN）. The study included a total of 88 patients, gross total resection was achieved in 70 patients（79.5%）, near total resection was obtained in 17 patients（19.3%）, and one patient undergoing subtotal resection. The average of intraoperative blood loss was 448.3 mL. Additionally, 24 patients underwent surgical total anterior rerouting（TAR）, 18 patients underwent surgical total FN tension free anterior rerouting（TF-TAR）, and 18 patients underwent surgical FN partial FN tension free anterior rerouting（TF-PAR）. Good postoperative FN function（House-Brackmann Ⅰ-Ⅱ） was achieved in 62.5% of TAR group. In the TF-TAR and PF_TAR groups, good postoperative FN function was demonstrated in 88.9% patients. It showed a significantly improvement of the FN function following application of tension-free FN anterior rerouting technique（=0.007）. Twenty patients（22.7%） suffered from at least one LCN deficit in the preoperative evaluation. The postoperative LCN deficits was correlated with the Fisch classification of tumors, which showed a lower incidence of LCN dysfunction in classes C1-C2（4.9%, 2/41cases） and poorer outcomes of LCN dysfunction in classes C3-D（8.5%,4/47cases ）, it was likely less impacted the LCN function in the early stage tumor. The application of modified surgical techniques of FN tension-free anterior rerouting and tunnel-packing of the inferior petrous sinus has been shown to effectively preserve the function of the FN and LCN, decrease intraoperative blood loss, and ultimately improve patients' postoperative quality of life.