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bjective To explore the surgical efficacy and complication treatment of suboccipital transcervicojugular approach for jugular foramen tumors. Methods The clinical data of 13 patients who underwent suboccipital transcervicojugular approach for jugular foramen tumors from April 2015 to May 2019 in the 1st Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The analyzation mainly comprised the image examination, surgical efficacy, post-op compliacations and treatment and the prognosis. Results Of 13 patients,the total resection was accomplished in 11 while subtotal resection in 2 and symptoms were relieved in. Postoperative CSF leakage occurred in 3 patients and cerebral infarction in 1. 5 patients endured the aggravation of posterior cranial nerves palsy, 3 of whom underwent tracheotomy. Conclusion Suboccipital transcervicojugular approach is an effective surgical approach for jugular foramen tumors. [ABSTRACT FROM AUTHOR]

Schwannomas encompassing the superior parapharyngeal space are challenging lesions because of the anatomical complexity of this region and the frequent involvement of the neurovascular structures of the jugular foramen. The purpose of this study is to report the technical aspects and the advantages of the anterolateral approach, here proposed for schwannomas of this complex area. The main steps of the anterolateral approach are described in detail, along with the results of a consecutive series of 38 patients with a retrostyloid superior parapharyngeal schwannoma involving the jugular foramen operated on by means of this route between 1999 and 2019. The supine position is generally preferred. The medial border of the sternocleidomastoid muscle, mastoid tip, and superior nuchal line are the landmarks for the hockey-stick skin incision. The accessory nerve is retrieved and mobilized cranially. Detachment of the sternocleidomastoid, digastric, and nuchal muscles allows for a 180° exposure of the extracranial side of the jugular foramen. Three working corridors, namely the pre-carotid, pre-jugular, and retro-jugular, allow access to the deeper part of the jugular foramen area and the superior parapharyngeal space. In the present series, a gross total resection was achieved in 89.4% of the patients. Three recurrences occurred after an average follow-up of 80.5 ± 51 months. The anterolateral approach is highly effective in the treatment of retrostyloid superior parapharyngeal space schwannomas involving the jugular foramen. Its simplicity of execution, versatility, and very low morbidity are among its main strengths. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value and applicability of resections for jugular foramen tumors through far lateral suboccipital supracondyle approach. Methods The clinical data of 75 patients with jugular foramen tumors operated by far lateral suboccipital supracondyle approach were analyzed. Of 75 patients, 28 were shwannomas, 25 paragangliomas, 11 meningiomas, 7 chordomas and 4 chondrosarcomas. The incision depended on the tumor extension direction and tumor size. Among the 75 cases, hook-shaped incisions were chosen in 42, curvilinear incisions were selected in 33. The vertebral artery and occipito-atlas joint were exhibited and jugular foramen was opened from supracondyle direction. Results of 75 patients, 51 received total resection of the tumors, 17 subtotal resection and 7 partial resection. Postoperative CSF leakage occurred in 5 cases. The patients were followed up from 3 to 24 months. Intraoperative neurophysiologic monitoring was beneficial to preservation of residual caudal cranial nerves. 33 cases had no newly-developed cranial nerve dysfunctions. 16 patients presented with slight hoarse and no dysphasia at the time of follow-up at least 3 months later. None permanent placement of gastro or tracheal tube. Conclusions The approach was performed without much more resection of petrous bone and skeletonization of facial nerve. We can get an extensive exposure without worsen the stability of crania-vertebral junction. The key of operation is to demonstrate different anatomy corridor according to the size and orientation of individual tumors. This approach is apt for the tumors with their main part within jugular foreman and extending to posterior fossa or craniocervical junction. [ABSTRACT FROM AUTHOR]

Schwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8th cranial nerve (the vestibulo-cochlear nerve) followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed. [ABSTRACT FROM AUTHOR]

Infratemporal fossa type A approach is the classical approach for resection of tumors in the jugular foramen, and the anterior rerouting of the facial nerve is an important procedure to facilitate tumor exposure. Dysfunction of facial nerve in patients following anterior facial nerve rerouting is great challenge to surgeons and patients. The author made great efforts to modify the surgical management of the facial nerve to improve facial nerve function. After dissection the facial nerve from the fallopian canal and the digastric muscle from the digastric ridge and styloid process, then the digastric muscle and parotid gland were suture with the inferior margin of temporal muscle. A long articulated retractor was placed at an angle of 45° to push the posterior belly of the digastric muscle and the parotid gland anteriorly and superiorly to further minimize the distance from the genicular ganglion to the main trunk of the facial nerve in the parotid gland. All the procedures resulted in tension free anterior rerouting of the facial nerve. Tension-free anterior rerouting of facial nerve not only reduces the tension of the facial nerve, but also preserves the maximal blood supply of the facial nerve, which are beneficial with the recovery of facial nerve function, postoperatively., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)