A COMBINED EXTRADURAL-POSTERIOR PETROUS AND SUBOCCIPITAL APPROACH TO THE JUGULAR FORAMEN TUMORS

An approach which improves on the conventional suboccipital craniectom y was used to explore a jugular foramen, a hypoglossal neurinoma, and a tentorial meningioma. A postero-medial mastoidectomy supplemented by the conventional suboccipital craniectomy made it possible to expose the entire sigmoid sinus. Subsequent medial retraction of the exposed sigmoid sinus and continuous dura mater and the extradural removal of petrous bone around the jugular foramen exposed the whole extracranial portion of the tumours. The tumours were totally removed by this appr oach in which the extradural route corresponded to the extracranial po rtion of the tumours and the suboccipital route to the intracranial po rtion. Facial nerve and hearing disturbances, which are frequent compl ications of the previous approaches, did not occur in our cases. Provi ding adequate exposure with simple surgical procedures and showing no adverse postoperative sequelae, this approach is most suitable for sur gery upon jugular foramen tumours with extracranial extension.