Tumors of the Jugular Foramen—Diagnosis and Management

Strategies and long‐term outcomes in the surgical management of tympanojugular paragangliomas

“…In the recent past, many authors have favored the technique of retaining the facial nerve in situ without rerouting it in the infratemporal fossa approach type A and/or attempt to conserve the external auditory canal in the resection of jugular fossa tumors. [20][21][22][23][24][25][26][27] Although it is true that some tumors could be removed this way, 28 it is incorrect to apply the principle for all classes of tympanojugular paragangliomas. The involvement of the intratemporal ICA and the infiltrative nature of the pathology must dictate the surgical approach.…”

“…The use of the far or extreme lateral approaches with various extensions have been proposed for the routine approach to the jugular fossa to preserve the middle ear and leave the facial nerve in situ, and even avoidance of drilling the petrous bone at all. 21,24,26,[38][39][40][41][42] It must be remembered that the far-lateral approach was initially developed to access lesions of craniocervical junction and ventral lower brainstem in order to limit brainstem retraction; pathology without significant involvement of temporal bone. 39,[43][44][45] However, this approach by itself limits the control of the intrapetrous carotid, and the ability to widely remove infiltrated bone.…”

Is the cranial accessory nerve really a portion of the accessory nerve? Anatomy of the cranial nerves in the jugular foramen

“…The microsurgical anatomy of the jugular foramen is crucial to the understanding of the neurological effects, diagnosis and management of tumors involving this region (Goldenberg & Gardner, 1991;Ayeni et al, 1995;Katsuta et al, 1997;Ibrahim et al, 1998;Kandel et al, 2000;Ramina et al, 2005). Discrepancies in terminology and fiber connections of the vagus nerve (CN X) and the accessory nerve (CN XI) in the jugular foramen necessitate revisiting this clinically important region.…”

Infratemporal fossa approach type a with transcondylar‐transtubercular extension for Fisch type C2 to C4 tympanojugular paragangliomas

“…4,[12][13][14][15] The use of the far or extreme lateral approaches with various extensions have been proposed for the routine approach to the jugular foramen to preserve the middle ear and leave the facial nerve in situ, and even avoidance of drilling the petrous bone. 9,28,41,[51][52][53][54][55] These approaches offer a wide posteroinferior access to the jugular foramen while keeping the facial nerve in place and preserving the external auditory canal and middle ear. In our opinion, the main drawbacks of these approaches are the limited superior and anterior access to the jugular foramen and the incomplete control of the whole intrapetrous ICA.…”