Learning Objectives: To share surigical experiences on management of temporal bone cholesteatoma invovling into jugular foramen.
Cholesteatoma involves into jugular foramen are rare. Clinical findings such as symptoms, signs, and preoperative hearing are frequently nonspecific in cases of temporal bone cholesteatoma, the surgical removal of cholesteatoma in this region is great challenge for the skull base surgeons. Eighteen cases with temporal bone cholesteatoma involving into jugular foramen were operated, the surgical approaches, intraoperative findings, surgical outcomes were retrospectively reviewed in the present study.
Eight cases are female, 10 cases are male, 8 cases in the left side, 10 in the right. The age ranges from 26-68 years old. The symptoms included hearing loss (17/18), otorrhea (8/18), pulsatile tinnitus (7/18), headache (2/18). Ten patients complained of facial paralysis, no patients suffered from the dysfunction of lower cranial nerves. All patients were undergone infratemporal fossa approach with facial fallopian canal bridge technique, Jugular foramen was erossion in all 18 cases, horizontal segment of ICA was encroached in 6 cases, sigmoid sinus and posterior fossa were compressed in 17 case. The clivus was destructed in 2 cases.
Facial nerve intact was remained in 6 patients , cable graft was conducted in 2 patients, facial hypoglossal nerve anastomosis was performed in two patients. Intraoperatively CSF leakage was incurred in 9 patients, sigmoid sinus or jugular bulb erupted in 3 cases, and sigmoid sinus occlusion with jugular vein ligation was undertaken. Eustachian tube was packed with temporal muscle and bone wax, the surgical cavity was packed with abdominal fat, blind sac closure was conducted in all patients. No major complications was observed.
Infratemporal fossa approach with facial nerve canal bridge technique is good option for patients with cholesteatoma involving into jugular foramen, which is sufficient to remove the lesion and control the vessels, as well to preserve facial nerve function.
