Day: July 13, 2026

J Neurosurg 145:120–131, 2026

This clinical article details a cadaveric and retrospective clinical study of the suprabulbar approach for resection of jugular fossa schwannomas, describing anatomical measurements, stepwise surgical technique, perioperative protocols, and outcomes in 22 patients treated between 1994 and 2024. The authors report a 77% gross-total resection rate, low morbidity, no mortality, and favorable cranial nerve preservation with mean follow-up of 31.4 months.

The paper emphasizes anatomical rationale from bilateral cadaver dissections to define the presigmoid infralabyrinthine window, operative nuances (mastoidectomy, presigmoid dura management, endoscopic assistance), and the approach’s versatility to combine intradural access with neck dissection for large dumbbell tumors while minimizing cranial nerve and venous complications.

Problem Jugular fossa schwannomas are rare lower cranial nerve tumors whose complex anatomy makes surgery difficult and morbidity-prone, especially for swallowing/voice deficits.

Approach The suprabulbar approach uses a presigmoid infralabyrinthine/retrofacial window created via mastoidectomy to access the jugular fossa while preserving the labyrinth and facial nerve, and enabling jugular bulb decompression.

Anatomic basis Cadaveric measurements characterized the surgical corridor (means: sigmoid sinus width 13.5 ± 3.9 mm; jugular bulb width 10.9 ± 1.4 mm; sigmoid-to-retrofacial space 12.8 ± 3 mm; labyrinth-to–jugular bulb dome 10.6 ± 2.6 mm; jugular foramen diameter 8.1 ± 1.2 mm).

Clinical series 22 patients (1994–2024) underwent resection; tumors were predominantly dumbbell-shaped type D (91%), mean max diameter 2.9 ± 1.1 cm, with frequent presenting dysphagia (64%) and hearing loss (41%).

Technique extensions Intradural tumor can be followed via presigmoid dural opening, distal tumor can be removed endoscopically, and caudal extracranial extension can be addressed with single-stage upper neck dissection when needed.

Resection outcomes Gross-total resection was achieved in 77% (17/22); subtotal resection occurred in 5 cases (including one due to intraoperative arrhythmias).

Safety profile No deaths or permanent neurological deficits; transient postoperative cranial nerve deficits occurred in 14% and resolved during follow-up; one perioperative complication was a suspected CSF leak treated with spinal drainage.

Follow-up/recurrence Mean follow-up was 31.4 months; 64% improved in preoperative neurological deficits; confirmed recurrence occurred in 14% (3/22), all successfully reoperated.