Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

Matthew Miller; Monica S. Pearl; Emily Wyse; Alessandro Olivi; Howard W. Francis

doi:10.1055/s-0035-1566302

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2016; 77(03): 249-259
DOI: 10.1055/s-0035-1566302

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

Matthew Miller

¹Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States

,

Monica S. Pearl

²Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States

,

Emily Wyse

²Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States

,

Alessandro Olivi

³Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, United States

,

Howard W. Francis

¹Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States

› Author Affiliations

Abstract

Objectives To describe an enhanced infralabyrinthine approach to petroclival lesions with jugular bulb decompression, and to quantify surgical access using a flat-panel computed tomography image protocol.

Design Retrospective case series and paired comparison of pre- versus post-dissection anatomy.

Setting Tertiary academic medical center.

Participants Four patients presenting with petroclival lesions. Six fresh cadaveric specimens were used for temporal bone dissection.

Main Outcome Measures Axial and coronal dimensions, and access angles of the infralabyrinthine surgical corridor.

Results Decompression of the jugular bulb increased the craniocaudal width of the infralabyrinthine corridor from 0.9 to 7.9 mm to 6.5 to 11.6 mm. The mean increase of 4 mm was statistically significant (t = 3.7; p < .05). There was also a significant widening of the infralabyrinthine window along the axial dimension by 0.9 to 4.5 mm or a mean of 2 mm (t = 3.7; p < .05). Angles of access to the petroclival region were wider following jugular bulb decompression, particularly in the coronal plane (mean difference 7.9 degrees; t = 5.0; p < .005) but less so in the axial plane (mean difference 4.7 degrees; t = 2.5; p = .05).

Conclusions Jugular bulb decompression enhances infralabyrinthine access to petroclival lesions, permitting the removal of tissue for diagnoses or partial resection, without significant additional morbidity.

Keywords

petroclival junction - transtemporal approach - jugular bulb decompression - flat-panel computed tomography

Full Text

References

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