Combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach for resection of glomus jugulare tumors

COMPLEX TUMORS OF the glomus jugulare present a surgical challenge because of their difficult location, extreme vascularity, and involvement with multiple cranial nerves. Modern microneurosurgical and cranial base techniques have enabled safe total removal of these complicated tumors. We describe a one-stage transjugular posterior infratemporal fossa approach for radical resection of glomus jugulare tumors located around the jugular foramen, the lower clivus, and the high cervical region from an anterolateral direction. This approach is a combination of transmastoid, suprajugular, transjugular, extreme lateral infrajugular transcondylar transtubercular, and high cervical approaches. Total exposure of the jugular foramen can be achieved, and multidirectional approaches can be performed, including infralabyrinthine/ suprajugular, retrosigmoid/transcondylar/infrajugular, and transjugular exposures. Exposure of the vertical C7 segment of the infratemporal internal carotid artery and the lower clivus can be performed without permanent rerouting of the facial nerve. The details of this approach are described and illustrated in a stepwise fashion, and the microsurgical anatomy is reviewed.