Transmastoid-Infralabyrinthine Tailored Surgery of Jugular Paragangliomas

Gjuric, Mislav; Bilić, Mario

doi:10.1055/s-0028-1103128

Cited by 22 publications

(20 citation statements)

References 22 publications

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“…More recently, the presigmoid infralabyrinthine approach has been discussed by some authors for pathologies of inframeatal petrous region (16,17,19). This approach also needs skeletonizing the sigmoid sinus and extensive drilling of mastoid and fallopian canal to expose the facial nerve, even though facial nerve rerouting is not mandatory.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

et al. 2015

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Introduction:Lesions of the petrous apex involving the inframeatal/infralabyrinthine region are challenging for surgical removal and have a high risk of approach related complications. Traditionally, various extensive skull-base approaches have been used for these lesions. The aim of this study was to present and evaluate our initial experience with a new hearing-preserving extension of the classic retrosigmoid approach to the inframeatal/infralabyrinthine area. Case Presentation: The approach was used in four patients harboring lesions in the petrous apex with variable extension in the inframeatal/infralabyrinthine region. The surgical accessibility of the lesions offered by the approach, completeness of tumor removal, the outcome, in particular, the functional outcome and complication rate, were assessed. Conclusions: The tumor could be gross totally resected in all the four cases. No approach-related morbidities occurred. Serviceable hearing and normal facial nerve functions were preserved in all cases. Our initial experience with the retrosigmoid inframeatal approach revealed that it provides sufficient access to the inframeatal/infralabyrinthine region and offers the possibility of complete tumor removal without any major complications. It allows for hearing and facial nerve functional preservation.

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Section: Discussionmentioning

confidence: 99%

Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

et al. 2015

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“…The authors also state that selection of this approach is dependent on the venous anatomy of the patient, and patency and dominance of the involved JB. 6 We believe that for benign tumors that do not invade the lumen of the SS and JB, even if preoperative imaging reveals occlusion of the venous outflow at the JF, the patency of these tumors can be restored postoperatively in the majority of cases. Therefore, we do not recommend using venous-sacrificing approaches in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to schwannomas, paragangliomas tend to invade the lumen of the SS, JB, and IJV more commonly. 2,6 In these conditions a more extensive approach with exposure of the major vessels in the neck, and sometimes ligation of the SS, JB, and IJV, is necessary for radical removal of the tumor. We recommend application of the "insideout" technique only for selected cases of paragangliomas that do not show significant invasion into the lumen of the sigmoid-jugular system on preoperative imaging.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,6 This approach also requires skeletonizing the SS and extensive drilling of the mastoid process and the fallopian canal to expose the facial nerve, even though facial nerve rerouting is not mandatory. The intradural exposure yielded by this approach is limited, and particularly the cisternal part of the lesion, brainstem, and CNs usually come into view only after a major bulk of the tumor has been removed.…”

Section: Discussionmentioning

confidence: 99%

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Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors

Samii

Alimohamadi

Gerganov

2016

JNS

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OBJECT Removal of jugular foramen (JF) tumors usually requires extensive skull base approaches and is frequently associated with postoperative morbidities such as lower cranial nerve injury. The endoscope-assisted retrosigmoid infralabyrinthine approach is a relatively new approach to tumors extending into the bony canal of the JF. The authors present their experience with this approach. METHODS The endoscope-assisted retrosigmoid infralabyrinthine approach was used in 7 patients, including 5 with schwannomas and 2 with paragangliomas. The access to the tumor, extent of its removal, postoperative neurological outcome, and approach-related morbidities were evaluated. RESULTS Two patients had a history of previous partial tumor removal, and 1 was treated by embolization followed by two courses of Gamma Knife radiosurgery. In this latter patient near-total resection was achieved. Gross-total resection was possible in the remaining 6 patients. Five patients benefited from endoscopic assistance: in 2 patients it showed a tumor remnant after microscopic tumor removal, while in 3 patients it allowed safe removal of the intraforaminal tumor by visualizing the surrounding structures. No permanent neurological deficit was observed after the operation. Two patients presenting with swallowing disturbance had temporary postoperative worsening that improved later. One patient developed CSF leakage that was managed with a lumbar drain. CONCLUSIONS This study shows that the judicious application of the endoscope-assisted retrosigmoid infralabyrinthine approach is safe and effective for removal of the schwannomas extending into the JF and selected paragangliomas without significant luminal invasion of the sigmoid-jugular system.

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“…This approach is actually a mixture of the extended recess described by McCabe et al14 and the post-aural hypotympanotomy described by Farrior15 and is not very much different from the transmastoid infralabyrinthine approach described by Gjuric M and Bilic M 16…”

Section: Operativementioning

confidence: 98%

Management of the Facial Nerve in Lateral Skull Base Surgery Analytic Retrospective study

Shazly

Elbadry

et al. 2011

Clin Med Insights Ear Nose Throat

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Background:Surgical approaches to the jugular foramen are often complex and lengthy procedures associated with significant morbidity based on the anatomic and tumor characteristics. In addition to the risk of intra-operative hemorrhage from vascular tumors, lower cranial nerves deficits are frequently increased after intra-operative manipulation. Accordingly, modifications in the surgical techniques have been developed to minimize these risks. Preoperative embolization and intra-operative ligation of the external carotid artery have decreased the intraoperative blood loss. Accurate identification and exposure of the cranial nerves extracranially allows for their preservation during tumor resection. The modification of facial nerve mobilization provides widened infratemporal exposure with less postoperative facial weakness. The ideal approach should enable complete, one stage tumor resection with excellent infratemporal and posterior fossa exposure and would not aggravate or cause neurologic deficit. The aim of this study is to present our experience in handling jugular foramen lesions (mainly glomus jugulare) without the need for anterior facial nerve transposition.Methods:In this series we present our experience in Kasr ElEini University hospital (Cairo—Egypt) in handling 36 patients with jugular foramen lesions over a period of 20 years where the previously mentioned preoperative and operative rules were followed. The clinical status, operative technique and postoperative care and outcome are detailed and analyzed in relation to the outcome.Results:Complete cure without complications was achieved in four cases of congenital cholesteatoma and four cases with class B glomus. In advanced cases of glomus jugulare (28 patients) (C and D stages) complete cure was achieved in 21 of them (75%). The operative complications were also related to this group of 28 patients, in the form of facial paralysis in 20 of them (55.6%) and symptomatic vagal paralysis in 18 of them (50%).Conclusions:Total anterior rerouting of the facial nerve carries a high risk of facial paralysis. So it should be reserved for cases where the lesion extends beyond the vertical ICA. Otherwise, for less extensive lesions and less aggressive pathologies, less aggressive approaches could be adopted with less hazards.

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Transmastoid-Infralabyrinthine Tailored Surgery of Jugular Paragangliomas

Cited by 22 publications

References 22 publications

Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors

Management of the Facial Nerve in Lateral Skull Base Surgery Analytic Retrospective study

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