Neurotologic Skull Base Surgery For Jugular Foramen Tumours

Abstract

The jugular foramen is a key structure in the skull base. Due to its location and its role as a neurovascular pathway, the management of jugular foramen tumors remains a challenge to both the ENT and neurosurgeons. Tumors of the jugular foramen may be intrinsic, arising within the jugular foramen, or extrinsic penetrating into it from an adjacent region. The classic tumor of ' this region is glomus jugulare tumor. Audiovestibular manifestations are by far the most common presentation followed by cranial nerves paralysis and other neurological deficits. The mainstay in the diagnosis and successful management of the jugular foramen lesions is the preoperative high quality and multimodality radiological assessment.

Numerous approaches are available for the jugular foramen, the jugular foramen can be approached from the anterior, lateral, or posterior direction, depending upon the site, size, extend and vascularity of the tumor, involvement of the surrounding neural, vascular and osseous structures and finally upon the patient's clinical condition. No . single, uniform approach can deal with all lesions

When approaching jugular foramen lesions, the facial nerve presents a significant obstacle of how to adequately expose and remove the tumor while still preserving facial function. The options of facial nerve management in skull base surgery are: anatomic localization only, transposition, elective division, segmental resection & reanimation by primary anastomosis or nerve grafting.