Surgery for Jugular Foramen Lesions

Seiffert is credited with the first surgical exploration of the jugular foramen for a patient with jugular foramen syndrome secondary to an intraluminal mass of the jugular bulb. Subsequently, numerous variations of the surgical approach to the jugular foramen region have been described.2,38,51,71-74 Early surgical approaches to large highly vascularized glomus tumors used tumor resection under temporary circulatory arrest,75 but the addition of preoperative embolization and improved surgical techniques obviates the need for circulatory arrest. The surgical approaches described in the literature combine dissection above and below the jugular foramen to isolate neurovascular structures both proximal and distal to the tumor. Jackson described an algorithm for selection of the appropriate surgical approach for glomus tumors that depend on the Glass-cock-Jackson classification of the tumor, which is based on preoperative imaging studies16,48,61,70,76 (Table 82-5). Fisch77 described in detail an infratemporal fossa approach to the lateral skull base for tumors of the jugular foramen, and divided this into three variations, types A to C, according to the anatomic limits of the tumor. Samii et al.51 termed their method for surgical management of jugular schwannomas the "combined cer-vical-mastoidectomy" approach. Otolaryngologists primarily manage glomus tympanicum tumors. Because this chapter details the neurosurgical perspective on jugular foramen tumors, management of glomus tympanicum tumors is not reviewed. Rather, emphasis is given to the management of glomus jugulare tumors and other lesions of the jugular foramen.

TABLE 82-5

Approach Algorithm for Glomus Tumors

Class

Glomus tympanicum

Glomus jugulare

From Jackson et al.48 and Jackson.70

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