Anatomic Study And Clinical Application Of Endoscopic Transcervical Appoach For Minimally Invasive Resecting Of Jugular Foramen Tumors

Objectives:To explore an endoscopic transcervical minimally invasive surgical approach to excise jugular foramen(JF)tumors,and to investigate its clinical feasibility.Methods:Five cadaveric head specimens(ten sides)attached necks were fixed with 10%formalin solution for anatomical study.Three of the heads were injected with colored silicone rubber.Through the endoscopic dissection by a straight incision at lower edge of earlobe,we recorded relations between facial nerve(CN.VII/FN)and other anatomical structures,and to find an available surgical channel.4 patients with JF tumors were underwent the transcervical surgery in clinical application,and recorded operation contents,preoperative and postoperative evaluations,and long-term followup.Results:Took the anterior branch of the retromandibular vein(RV)that was about 1 cm above the angle of mandible(Ar-Go-Me)plane as the anterior edge,took 1 cm above the plane where the posterior auricular vein(PAV)joined the posterior branch of the RV to form the external jugular vein(EJV)as the upper edge.Set the point of the intersection of the posterior branch of the RV and the upper edge,formed a line from this point and the peak of the anterior edge as the superior anterior edge,and linked together with the posterior border of the parotid gland(PG)to form the resection range of the PG,which would help to avoid FN.Surgical access for the carotid sheath and part of the anterior JF were performed through digastric(DIG)and stylohyoid muscle(SM).The rectus capitis lateralis(RCL)and vertebral venous plexus(VVP)were removed to expose the atlanto-occipital joint,and to reach the posterior and lateral side of JF.By removing the joint bone from the posterolateral aspect of the JF to foramen magnum could effectively expose the ventral aspect of cerebellum and lateral side of medulla oblongata.However,the exposures of the cerebellopontine angle and the front of the brainstem were poor.4 patients were underwent the endoscopic transcervical surgery,1 received gross total resection,the others got subtotal tumor resection.3 patients had temporary posterior cranial nerve injury after operation,3 patients without facial paralysis before surgery only showed temporary motor deviated mouth,all patients recovered after rehabilitation treatments.1 patient appeared new swallowing disturbance and needed long-term use of gastric-tube feeding.Conclusion:The endoscopic transcervical approach can expose the posterior,lateral,and part of the anterior side of JF.By removing the OC and lateral mass can expose the ventral aspect of cerebellum and lateral side of medulla oblongata.By locating the RV and Ar-Go-Me can help to avoid intra-parotid FN to protect it.Altogether,this approach has certain clinical feasibility and can be popularized.