Surgical Treatment and Postoperative Management

Abstract

The multidisciplinary approach to jugular foramen tumors permits to manage possible surgical difficulties and complications. Choice of approach is based on tumor extension. Two main surgical approaches have been used in our series: (a) the modified retrosigmoid approach in cases of predominantly intradural lesions without extensions to the cervical region and involvement of the internal carotid artery (ICA). Meningiomas, schwannomas, chordomas, chondrosarcomas, and some paragangliomas are the most frequent jugular foramen tumors removed through this approach. (b) The cranio-cervical approach when the tumor extends into the cervical region, retropharyngeal space, involves the clivus, the ICA, the vertebral artery, the jugular bulb, and the internal jugular vein. Paragangliomas, schwannomas, and large meningiomas are the most frequent lesions resected through this approach. CSF fistula is a frequent postoperative complication due to the large surgical defect caused by bone and dura removal. A special technique using vascularized myofascial flaps was developed to reconstruct the cranial base.