MANAGEMENT OF THE JUGULAR BULB DURING LATERAL SKULL BASE SURGERY

The intraoperative management of a pate jugular bulb presents a formid able challenge during the treatment of lateral skull base lesions. Whe ther to preserve, partially occlude, or completely sacrifice this crit ical structure is a decision best made following a multifactorial anal ysis of preoperative clinicoradiographic data, tumor histopathology, a nd intraoperative findings. Twenty-six patients with tumors requiring dissection near a pate jugular bulb were reviewed. Ten patients had su perior neck tumors, nine had primary temporal bone lesions, and seven presented with recurrent parotid malignancies. The most common clinica l manifestations were headache and vocal cord paralysis and the most s ignificant radiographic finding was the presence of a mass at the styl oid base. Jugular bulb patency was preserved in six patients, partiall y maintained in seven, and was sacrificed in 13 individuals. This arti cle focuses on the clinicoradiographic findings in patients with neopl astic jugular foramen encroachment, but preserved jugular blood flow. Surgical technique will be detailed through selected case presentation s and the management of lower cranial nerve injuries will be reviewed.