Microsurgical management of 150 jugular foramen tumors: Advanced cranial base microanatomy and operative results

Abstract

Surgical management of jugular foramen tumors poses a very difficult problem and a formidable challenge. Microsurgical total resection may not be feasible to preserve critical neurovascular structures and to avoid operative complications, even with our current advanced skull base techniques. Surgical resectability depends upon the tumor size and extension, adhesions and engulfment with cranial nerves and vessels, presenting symptoms, and tumor histology as well as vascularity. Experience in the past has shown that the traditional suboccipital or transmastoid approaches do not provide adequate exposure of these lesions. Advances in neuroradiologic imaging, microsurgical techniques, and cranial base approaches have allowed extended operative access and dissection all around the jugular foramen region with much decreased morbidity. This article presents contemporary understanding of microanatomy of jugular foramen, improved operative exposure, grading scale of tumor extension, and clinical summary of 150 cases (1980–2007).