Evaluation of the Petro-occipital transsigmoid approach for resection of Non-vascular lesions of the jugular Foramen.

Abstract

BACKGROUND:Lesions affecting the jugular foramen (JF) other than paragangliomas are uncommon. Of those, schwannomas and meningiomas predominate with little data describing them in the literature. OBJECT:To evaluate the safety and efficacy of the petro-occipital transssigmoid (POTS) approach for resection of non-vascular lesions of the jugular foramen. METHODS:This descriptive study was conducted on 12 consecutive patients affected by various jugular foramen lesions, other than paragangliomas, who were treated by the POTS approach. Computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain and magnetic resonance venography (MRV) were performed for all patients. The extent of resection and clinical outcome were assessed. Patients were followed up clinically by Karnofsky performance scale score and radiologically by CT and MRI for average of 1 year. RESULTS:A single-stage resection using the POTS approach was used for all patients. Gross total resection was achieved in 66.6%. Tumors included schwannomas (6 cases), meningiomas (3 cases), chondrosarcomas (2 cases) and plasma cell tumor (1 case). This approach allowed adequate resection of both intradural and extradural components of the tumor with hearing preservation and avoidance of facial nerve transposition. There was no mortality. Variable grades of cranial nerve palsies were encountered, but none of the patients required an adjunctive procedure such as vocal cord medialization, tracheostomy, or percutaneous gastrostomy. CONCLUSION:The POTS approach provided adequate tumor exposure for safe resection in a single-staged procedure with access to both the intracranial (extradural and intradural) and extracranial components. It allows moderate rates of hearing preservation and good rates of facial function preservation with minimal related morbidity.