Retrosigmoid Craniotomy for Endoscope-Assisted Resection of a Jugular Foramen Schwannoma: 2-Dimensional Operative Video

Type D jugular foramen schwannomas are dumbbell-shaped tumors involving both intracranial and extracranial compartments. Several approaches have been described including presigmoid infralabrynthine, cervicomastoid, and extreme lateral infragular transcondylar exposure. We sought to demonstrate how the retrosigmoid approach, which is typically reserved for Type A or solely intracranial tumors, can be adapted for a Type D tumor with the aid of the endoscope. A 62-year-old woman presented with 3 months of left-sided hearing loss, dizziness, and gait ataxia. MRI demonstrated a heterogeneously enhancing mass centered at the left jugular foramen with a large cisternal component in the cerebellopontine angle as well as an extracranial component extending toward the infratemporal fossa. Computed tomography demonstrated expansion of the jugular foramen with erosion of the petrous bone. These findings were consistent with a Type D jugular foramen schwannoma. A retrosigmoid craniotomy was performed, and the cisternal tumor was removed using standard microsurgical techniques. The tumor seemed to originate from the glossopharyngeal nerve. The endoscope was used to remove tumor within the jugular foramen and extracranially toward the infratemporal fossa. A near total resection was achieved, and the patient's gait ataxia improved. Combined with the retrosigmoid craniotomy, the endoscope is a useful adjunct for accessing tumors that expand the jugular foramen and grow toward the infratemporal fossa. Owing to the foraminal expansion and bony erosion, the tumor created a path for the endoscope that allowed us to avoid a larger skull base approach. The patient consented to the procedure and to the publication of her image.