Jugular paragangliomas—Resection techniques

The prerequisites for surgical resection of tumors arising in the jugular foramen are adequate access, control of the major vessels, and the ability to move the facial nerve safely of the operative field if necessary. Without it the surgeon risks catastrophic hemorrhage, cranial nerve palsies that might have been avoided, and insufficient access to remove the whole tumor. The aim of this article is to help the surgeon select the best approach for their patient and summarize the key steps in each. Consideration of a staged approach is prudent for paragangliomas that have significant intracranial extension, Fisch Di tumors. Paragangliomas confined to the temporal bone and intimately related to the internal carotid artery (ICA), Fisch C2-4, are better resected through a type A infratemporal fossa approach. Small jugular paragangliomas, Fisch C1, can be removed using a Fallopian bridge technique though limited rerouting of the facial nerve may sometimes be required.