Pure endoscopic presigmoid infralabyrinthine approach for jugular foramen tumors: Operative technique and early results.

Background: Jugular foramen (JF) tumors are uncommon, often requiring surgical resection due to their complex anatomical location and varied growth patterns, particularly when intraosseous.

Objective: We propose the pure endoscopic presigmoid infralabyrinthine approach (EPSIL) as a minimally invasive technique for lateral JF access during tumor resection, circumventing the need for extensive exposure of vital structures and jugular vein sacrifice.

Methods: A retrospective analysis was conducted on six patients who underwent EPSIL for JF tumor resection since 2020. The focus was on operative techniques, extent of tumor removal, neurological outcomes, and approach-related morbidity.

Results: The cohort included six patients (three male, three female) with an average age of 46.9 years and a follow-up of 21.6 months. Tumor types were four schwannomas, one paraganglioma, and one chondrosarcoma (WHO grade 2), with average dimensions of 41.2 × 18.8 × 34.5 mm. All were successfully removed via EPSIL, aided by neuro-navigation and monitoring. Four achieved gross-total resections, two subtotal (>90 %), with the latter treated with Gamma Knife for remnants. No tumor recurrence or growth was noted. Preoperative symptoms improved postoperatively, with temporary hoarseness and slight hearing impairment resolving within 8 weeks. One patient had a cerebrospinal fluid leak, managed with a lumbar drain, without long-term deficits.

Conclusion: The EPSIL approach is a highly effective method for the removal of JF tumors, particularly those with intraosseous growth. It stands out as a minimally invasive procedure that harmoniously integrates radical tumor resection with the preservation of cranial nerves.