jugular foramen tumor resection

Although the tumor of the jugular foramen is rare, it is difficult to operate, and it has always been one of the focuses of neurosurgery and related specialists. Tumors in this area include jugular bulbar tumor, schwannomas, meningioma, epithelioid cyst, dermoid cyst, chordoma, chondroma, rhabdomyosarcoma, malignant lymphoma, metastatic cancer, and the like. Here, the basic method of tumor resection in the jugular foramen is described by schwannomas. Treatment of diseases: meningioma Indication Once the benign tumor of the jugular foramen is diagnosed, it should be surgically removed. Contraindications The patient has poor general condition or has significant organ dysfunction. Preoperative preparation The blood supply of schwannomas is not abundant, but it is confirmed by individual angiography that there are abundant branches of the external carotid artery (mainly pharyngeal ascending artery), and embolization can be performed before operation. Surgical procedure Anesthesia and position Tracheal intubation for general anesthesia. If the posterior mastoid-mammary approach is used, the supine position is taken, the shoulder of the affected side is raised, and the head is rotated 45° to the opposite side. Surgical procedure Incision After the mastoid-mammary process, the skin, subcutaneous tissue, muscle and periosteum were cut slightly along the mastoid, and separated under the periosteum to reveal the posterior part of the humerus, mastoid and occipital bone. The inferior end of the skin and subcutaneous tissue incision reaches the anterior border of the sternocleidomastoid muscle. 2. Posterior mastoid bone window formation and mastoidectomy In the posterior aspect of the mastoid, the upper sinus and the transverse sinus merge into a sigmoid sinus to drill a bone hole, and then drill a number of holes in the upper and lower sinus and the sigmoid sinus, bite the bone hole and the adjacent skull. Form a bone window. Use a small high-speed drill to remove the mastoid, but pay attention to retain the facial nerve tube and listen to the small bone. The bone on the surface of the sigmoid sinus was removed and the full length of the sigmoid sinus was revealed. 3. Tumor exposure and resection The dura mater was cut along the posterior edge of the sigmoid sinus. After the arachnoid was removed from the arachnoid, the cerebellar hemisphere was gently retracted upwards to reveal the tumor in the jugular foramen. The relationship between the tumor and the posterior cranial nerve was carefully identified. . If the nerve and the tumor cannot be separated, they can only be cut off. The dura mater in the posterior cranial sinus in front of the sigmoid sinus was separated from the back of the rock bone and then retracted to the medial side, and the rock bone before the sinus was removed by about 0.5 cm. The sigmoid sinus at the proximal end of the sinus sinus is double-ligated and the sinus is severed between the ligatures. The internal jugular vein is exposed and ligated near the base of the skull. Reveal and remove the transverse process of the atlas, gently retract the vertebral artery, remove the posterior wall of the jugular foramen and the occipital bone at the proximal end of the sigmoid sinus. The posterior wall of the jugular foramen is open, taking care not to damage the stem. The facial nerve through which the milk hole passes. So far, the tumor extending through the jugular vein and the extracranial tumor have been completely revealed. The tumor was resected or removed together with the sigmoid sinus, the distal jugular vein, and the 9th to 11th cranial nerves. 4. Suture incision Closely repair and suture the dura mater in the posterior fossa. The residual mastoid air chamber is sealed with bone wax, and the residual cavity formed after the mastoidectomy is filled with muscle (sternocleidoma) or fat. Muscle, subcutaneous tissue and skin are sutured layer by layer. complication 1. Cranial nerve injury includes posterior cranial nerve and facial nerve injury. 2. Cerebrospinal fluid leakage.