A hearing preservation technique for the resection of extensive jugular foramen tumors

Objective. To describe a modified surgical approach for patients who mainta in hearing function with jugular foramen tumors that extend to the posterio r cranial fossa and the neck. Study Design: A retrospective review of 6 pat ients with jugular foramen tumors that were resected by a combined suboccip ital and infralabyrinthine-transcervicomastoid approach. Methods: A combine d suboccipital and infralabyrinthine-transcervicomastoid approach is charac terized as follows: 1) There is no ablation of ear structures except the in fralabyrinthine mastoid bone; the auricle is retracted anteriorly while pre serving the bony wall and skin of the ear canal. 2) After superficial parot idectomy, a limited length of nerve VII from the intratemporal. vertical se gment is rerouted to divisions of the parotid portion. 3) The tumor is remo ved along with the internal jugular vein and sigmoid sinus, then the extend ed intracranial. mass is resected through an additional suboccipital approa ch. Results: Five of the 6 patients had complete removal of all gross tumor s. There were no major complications or mortalities. The preoperative level s of hearing were preserved in 5 of the 6 patients. Favorable facial functi on in the immediate postoperative period was noted in 4 of the 6 patients. Incomplete paralysis of 2 patients recovered eventually. Conclusion: We pro pose that a combined suboccipital and infralabyrinthine-transcervicomastoid approach to the jugular foramen can provide sufficient exposure to resect most dum ell shaped tumors, and it could be the initial treatment of choice for patients with remnant hearing.