Abstract：
Owing to their scarcity, location, and intricate neurovascular associations, jugular fossa tumors are among the most challenging pathologies encountered by the neurosurgeon.1 While paragangliomas originate within and often occlude the jugular bulb, schwannomas and meningiomas are extra-bulbar and typically do not impede venous flow.2 Schwannomas typically arise from an extradural origin, expanding the jugular foramen.3-5 Meningiomas are intradural and cause hyperostosis of the jugular tubercle.6 We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window6 that has been detailed in cadaveric studies.7,8 This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves. The carotid artery can be identified by neuronavigation and micro-Doppler ultrasonography. This approach provides a direct lateral trajectory with a short distance to the jugular fossa and cerebellopontine angle. Early exposure and central debulking of the tumor minimize manipulation of the exquisitely sensitive lower cranial nerves. The distal aspect of these tumors can be removed with endoscopic assisted techniques.9 The first patient is a 49-yr-old woman with a previously irradiated schwannoma who presented with worsening neurologic deficits-an extradural suprabulbar approach was used to resect this tumor. The second patient is a 27-yr-old woman with an enlarging meningioma and associated neurological dysfunction; this tumor was resected using the suprabulbar approach with opening of the presigmoid dura. Both patients have consented to surgery and publication of images. Image at 2:27 and 6:38 reprinted from Arnautović et al, with permission from JNSPG. Image at 2:50 and 6:45 ©Ossama Al-Mefty 1997, reused with permission.
摘要：
由于它们的稀缺性，location,和复杂的神经血管关联，颈静脉窝肿瘤是神经外科医生遇到的最具挑战性的病理之一。1虽然副神经节瘤起源于颈静脉球内并经常阻塞，神经鞘瘤和脑膜瘤是球外肿瘤，通常不会阻碍静脉血流。2神经鞘瘤通常起源于硬膜外，3-5脑膜瘤是硬膜内的，并引起颈静脉结节的骨肥大。6我们描述并一直通过尸体研究中详细介绍的乙状结肠上横列下窗口暴露和切除颈静脉窝肿瘤。适用于听力部分受损且下颅神经完整的病例。颈动脉可以通过神经导航和微多普勒超声检查来识别。这种方法提供了到颈静脉窝和小脑桥脑角的短距离的直接横向轨迹。肿瘤的早期暴露和中央切除可最大程度地减少对精密敏感的下颅神经的操纵。这些肿瘤的远端可以通过内窥镜辅助技术切除。9第一名患者是一名49岁的女性，患有先前接受过照射的神经鞘瘤，表现为神经功能缺损恶化-硬膜外横上入路用于切除该肿瘤。第二位患者是一名27岁的女性，患有扩大的脑膜瘤和相关的神经功能障碍；该肿瘤是使用上横杆方法切除的，并打开了脑膜硬膜。两名患者都同意手术并发表图像。图片在2：27和6：38转载自Arnautović等人，获得JNSPG的许可。图片在2：50和6：45©OssamaAl-Mefty1997，经许可重复使用。
