Skull Base 2009; 19(1): 043-047
DOI: 10.1055/s-0028-1103129
© Thieme Medical Publishers

Juxtacondylar Approach in Temporal Paraganglioma Surgery: When and Why?

Joerg Schipper1 , Uwe Spetzger2 , Marcos Tatagiba3 , Steffen Rosahl4 , Hartmut P.H Neumann5 , Carsten Christof Boedeker1 , Wolfgang Maier1
  • 1Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University of Freiburg, Germany
  • 2Department of Neurosurgery, Städtische Kliniken Karlsruhe, Germany
  • 3Department of Neurosurgery, University of Tübingen, Germany
  • 4Department of Neurosurgery, Neurozentrum, University of Freiburg, Germany
  • 5Department of Nephrology, Albert-Ludwigs-University, Freiburg, Germany
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
12. Januar 2009 (online)

ABSTRACT

As it became clear that patients with paraganglioma (PGL) syndromes had a higher risk of multifocal tumors, we changed our surgical strategy to avoid the possibility of bilateral cranial nerve paralysis. The juxtacondylar approach offers advantages for some jugular foramen tumors, including types C and D temporal PGLs. This approach allows exposure of the jugular foramen without skeletonizing or transposing the facial nerve. It improves the surgeon's ability to distinguish between the pars vascularis and the pars nervosa at the jugular foramen, and it helps to save functioning of the lower cranial nerves. There is already considerable experience using the juxtacondylar approach for patients suffering from schwannomas and meningiomas involving the jugular foramen. Some limitations have been noted for using the juxtacondylar approach with jugular PGLs that are related to their vascular nature. In this article we demonstrate its use for the management of eight patients with locally advanced temporal PGLs and how it can be combined with an infratemporal fossa approach.

REFERENCES

  • 1 Neumann H P, Bausch B, McWhinney S R Freiburg-Warsaw-Columbus Pheochromocytoma Study Group et al.. Germ-line mutations in nonsyndromic pheochromocytoma.  N Engl J Med. 2002;  346 1459-1466
  • 2 Neumann H P, Pawlu C, Peçzkowska M European-American Paraganglioma Study Group et al.. Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations.  JAMA. 2004;  292 943-951
  • 3 Schiavi F, Boedeker C C, Bausch B European-American Paraganglioma Study Group et al.. Predictors and prevalence of paraganglioma syndrome associated with mutations of the SDHC gene.  JAMA. 2005;  294 2057-2063
  • 4 Schipper J, Boedeker C C, Maier W, Neumann H P. Paragangliomas in the head/neck region. Part I: Classification and diagnosis.  HNO. 2004;  52 569-574
  • 5 Fisch U. Infratemporal fossa approach for glomus tumors of the temporal bone.  Ann Otol Rhinol Laryngol. 1982;  91 474-479
  • 6 Fisch U, Mattox D. Microsurgery of the Skull Base. Stuttgart; Thieme 1988: 149-153
  • 7 Schipper J, Boedeker C C, Maier W, Neumann H P. Paragangliomas of the head and neck. Part 2: Therapy and follow-up.  HNO. 2004;  52 651-660
  • 8 Schipper J, Arapakis I, Ridder G J, Maier W, Spetzger U. Microsurgical resection of jugular foramen tumors with hearing preservation and without facial nerve palsy.  HNO. 2003;  51 721-727
  • 9 Leonetti J P, Brackmann D E, Prass R L. Improved preservation of facial nerve function in the infratemporal approach to the skull base.  Otolaryngol Head Neck Surg. 1989;  101 74-78
  • 10 Jackson C G, Harris P F, Glasscock III M E et al.. Diagnosis and management of paragangliomas of the skull base.  Am J Surg. 1990;  159 389-393
  • 11 Bertalanffy H, Seeger W. The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction.  Neurosurgery. 1991;  29 815-821
  • 12 Friedrich H, Seeger W. Microsurgery in pre-pontine tumours.  Neurochirurgia (Stuttg). 1976;  19 246-259
  • 13 Goel A, Desai K, Muzumdar D. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases.  Neurosurgery. 2001;  49 102-106
  • 14 Heros R C. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions.  J Neurosurg. 1986;  64 559-562
  • 15 Kaye A H, Hahn J F, Kinney S E, Hardy Jr R W, Bay J W. Jugular foramen schwannomas.  J Neurosurg. 1984;  60 1045-1053
  • 16 Day J D, Kellogg J X, Tschabitscher M, Fukushima T. Surface and superficial surgical anatomy of the posterolateral cranial base: significance for surgical planning and approach.  Neurosurgery. 1996;  38 1079-1084
  • 17 George B, Lot G, Tran Ba Huy P. The juxtacondylar approach to the jugular foramen (without petrous bone drilling).  Surg Neurol. 1995;  44 279-284
  • 18 George B, Tran P B. Surgical resection of jugulare foramen tumors by juxtacondylar approach without facial nerve transposition.  Acta Neurochir (Wien). 2000;  142 613-620
  • 19 Gilsbach J M, Sure U, Mann W. The supracondylar approach to the jugular tubercle and hypoglossal canal.  Surg Neurol. 1998;  50 563-570
  • 20 Babu R P, Sekhar L N, Wright D C. Extreme lateral transcondylar approach: technical improvements and lessons learned.  J Neurosurg. 1994;  81 49-59
  • 21 Salas E, Sekhar L N, Ziyal I M, Caputy A J, Wright D C. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients.  J Neurosurg. 1999;  90(suppl) 206-219
  • 22 Fukushima T. Combined supra- and infra-parapetrosal approach for petroclival lesions. In: Sekhar LN, Janecka IP Surgery of Cranial Base Tumors. New York; Raven Press 1993: 661-669
  • 23 Sasaki T. Surgical approaches to the tumors in and around the jugulare foramen.  No Shinkei Geka. 1994;  22 1111-1118
  • 24 Maniglia A J, Sprecher R C, Megerian C A, Lanzieri C. Inferior mastoidectomy-hypotympanic approach for surgical removal of glomus jugulare tumors: an anatomical and radiologic study emphasizing distances between critical structures.  Laryngoscope. 1992;  102 407-414
  • 25 Zentner J, Albrecht T, Hassler W. Prevention of an air embolism by moderate hypoventilation during surgery in the sitting position.  Neurosurgery. 1991;  28 705-708

Professor Dr. Joerg Schipper

Head of the Department of ORL and HN Surgery, University of Duesseldorf

Moorenstrasse 5, 40225 Duesseldorf, Germany

eMail: joerg.schipper@med.uni-duesseldorf.de