Surgical Treatment of Selected Tumors via the Navigated Minimally Invasive Presigmoidal Suprabulbar Infralabyrinthine Approach without Rerouting of the Facial Nerve

Abstract BACKROUND: The feasibility of a novel skull base approach, the navigated minimal ly invasive presigmoidal suprabulbar infralabyrinthine approach (NaMIPSI-A) without rerouting of the fallopian canal for selected jugular foramen tumors (JFTs), has been demonstrated in a neuroanatomical laboratory study. OBJECTIVE: Here, we present our clinical experience with this approach for selected JFTs, with a particular focus on its efficacy and safety. METHODS: All patients with JFTs who were treated via the NaMIPSI-A were included in this study. The JFTs were classified according to a modified Fisch classification. The neurological and neuroradiological outcome, the extent of tumor resection, and the approach-related morbidity were examined.RESULTS: Five patients (two women, three men; mean age 57y, range 48-65) were available. According to the modified Fisch classification, two JFTs were graded as C1, one as De1 and two as De2. Gross total resection (GTR) was achieved in three patients and near-total resection (NTR) in two. Postsurgically, no new neurological deficits and no approach-related morbidity and mortality occurred. One case with a postoperative cerebrospinal fluid leak was managed successfully with lumbar drainage. During the follow-up period (mean 67,6 months, range 12-119 months) tumor recurrence was noted in the NTR group but not in the GTR group. CONCLUSIONS: The NaMIPSI-A to the jugular foramen without rerouting of the fallopian canal is highly valuable for selected tumors of the jugular foramen. It is less invasive than other skull approaches, and it allows safe and complete tumor removal in appropriate patients.