Management of jugular bulb injury during retrosigmoid transmeatal resection of vestibular schwannoma

Abstract

Inadvertent laceration of the jugular bulb is a potentially serious complication of the retrosigmoid transmeatal approach to vestibular schwannomas. Here, the authors present the case of a 51-year-old woman with a right Hannover T4a vestibular schwannoma and bilateral high-riding jugular bulb, which was opened during drilling of the internal auditory canal (IAC). They highlight the immediate management of this complication, technical nuances for closing the defect without occluding the jugular bulb, and modifications of the standard technique needed to continue surgical resection. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2155

Retrosigmoid Infralabyrinthine (Suprajugular) Approach to the Jugular Foramen: Indications, Limitations, and Surgical Nuances

“…A high-riding JB may be a contraindication for this approach if it reaches the IAC; otherwise, unroofing the JF may be performed as usual, and the bulb may be pushed downward with a cotton pattie to access the anteromedial JF. Laceration of the JB during suprajugular drilling is managed in the same way as laceration during transmeatal drilling, 20 using a small muscle patch to occlude the defect, then working around it. It bears to remember that schwannomas with a large intrajugular component tend to partially collapse the JB, pushing it against the lateral wall of the foramen, and creating a large working space after suprajugular drilling; however, debulking the intrajugular tumor will produce re-expansion of the bulb.…”