Comparative results of infratemporal fossa approach with or without facial nerve rerouting in jugular fossa tumors

Abstract

Jugular fossa tumors are uncommon diseases. During the surgery and due to the interposition of the facial nerve in the tumor approach, the facial nerve must be elevated from the fallopian canal and placed permanently into an anterior position. Although this maneuver provides a wide exposure, most of the patients suffer a long-term total or partial facial palsy. The purpose of this article is to check whether the infratemporal fossa approach without transposition of the facial nerve is equivalent to the approach with rerouting of the facial nerve regarding postsurgical morbidity. The clinical records of 52 patients who underwent an infratemporal fossa approach were reviewed in which 34 patients were segregated into two comparable groups regarding the presence or absence of transposition of the facial nerve. There were 19 women and 15 males. The majority of the patients (73%) had jugular paragangliomas. The mean follow-up of the full series was 66 months. It was statistically significant that the worst facial nerve function at hospital discharge was in the patients who underwent facial nerve transposition (p = 0.001). Equally the facial nerve function in the no-rerouting group 1 year after the surgery was significantly much better than in the rerouting group (p = 0.003). Regarding to survival, recurrence or complications no significant differences were observed between both groups. Our study suggests that most of cases avoiding facial nerve transposition allow significant better functional results thereof without affecting other parameters such as recurrence, complications or survival.

Facial nerve management in jugular paraganglioma surgery: a literature review

“…11 They consider this approach to have limited indications because it is very difficult to remove extensive jugular paragangliomas while leaving the facial nerve in situ. 12 In the non-rerouting group, total tumour resection was achieved in 64 per cent of patients, and House-Brackmann grade I-II function in 100 per cent. However, Russo and colleagues consider this approach to be indicated for non-vascular jugular foramen tumours that do not infiltrate the surrounding bone or ICA adventitia, such as lower cranial nerve schwannomas and meningiomas.…”

Outcomes of Facial Nerve in Lateral and Inferior Mastoid Approaches for Jugular Foramen and Petrous Apex Lesions

“…Hence, it is desirable to either work around it or, if not possible, rerouting is needed before tumor is removed. 6 Llorente et al 7 found no difference in the surgical exposure attained or the tumor removal possible by mobilizing (rerouting) the temporal part of the facial nerve. Contradicting this are studies of cadaveric dissection by Von Doersten and Jackler, 8 which quote a wider corridor for surgery and lesion removal as well as fewer recurrences 9 on rerouting the facial nerve.…”

Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives

“…The hypervascular nature of these tumors further complicates surgical management. Despite advances in surgery [17,18], extensive resection of GJT has great potential to leave the patients with substantial treatment-related morbidity, which should be considered as a high cost for the management of a mostly benign tumor [19][20][21].…”