Extracranial Jugular Foramen Schwannomas Treated with the Extreme Lateral Juxtacondylar Approach: Surgical Technique and Our Experience

Abstract

BACKGROUND: Schwannoma that arises in the jugular foramen (JF) represents an important challenge for neurosurgeons for its precise location, extension, and neurovascular relationship. Nowadays, different managements are proposed. In this study, we present our experience in the treatment of extracranial JF schwannomas (JFss) with the extreme lateral juxtacondylar approach (ELJA). OBJECTIVE: To present our experience in the treatment of extracranial JF schwannomas (JFss) with the ELJA. METHODS: Between January 2013 and January 2017, 12 patients with extracranial JFs underwent surgery by ELJA. All lesions were type C of the Samii classification. Indocyanine green videoangiography was used to evaluate the relationship between the internal jugular vein and the tumor and to control the presence of spasm in the vertebral artery. RESULTS: A complete exeresis was achieved in 9 patients while in 3 patients, it was subtotal. The complete regression of symptoms was obtained in 7 patients with a total resection. The remaining cases experienced a persistence of symptoms. CONCLUSION: The success of this surgery is achieved through a management that starts from the patient's position. We promote an accurate evaluation of JFs through the Samii classification: Type C tumors allow the use of ELJA that reduces surgical complications. Furthermore, we recommend the use of indocyanine green videoangiography to preserve the vessels and prevent vasospasm.

Outcomes after Surgical Resection of Jugular Foramen Schwannomas: Systematic Review and Meta-Analysis

“…The pooled perioperative mortality rate was 4% (95% CI: 2-6; I 2 ¼ 0%). CSF leak rates were reported in 18 studies 3,5,10,[14][15][16][19][20][21][22][23][24][25][26]28,31,33,34 and the pooled rate was 9% (95% CI: 6-15; I 2 ¼ 43.9%). Tracheostomy rates were reported in 16 studies.…”

“…Tracheostomy rates were reported in 16 studies. 5,14,15,[17][18][19][20][23][24][25]27,28,30,[33][34][35] The pooled tracheostomy rate was 8% (95% CI 5 -12, I 2 = 20.8%). There were 22 studies 3,5,10,[14][15][16][17][18][20][21][22][23][24][25][26][27][28][29]31,32,34,35 that reported rates of new or worsening postoperative symptoms or neurologic deficits from which pooled rates were calculated (Supplemental figures).…”

“…5,14,15,[17][18][19][20][23][24][25]27,28,30,[33][34][35] The pooled tracheostomy rate was 8% (95% CI 5 -12, I 2 = 20.8%). There were 22 studies 3,5,10,[14][15][16][17][18][20][21][22][23][24][25][26][27][28][29]31,32,34,35 that reported rates of new or worsening postoperative symptoms or neurologic deficits from which pooled rates were calculated (Supplemental figures). These included hearing loss: 12% (95% CI 7 -20, I 2 = 69.4%), dysphagia: 27% (95% CI 20 -36, I 2 = 66%), hoarseness: 20% (95% CI 14 -28, I 2 = 62.6%), facial palsy: 19% (95% CI 13 -28, I 2 = 64.6%), and hypoglossal nerve palsy: 9% (95% CI 7 -12, I 2 = 0%).…”

“…There were 16 studies that reported postoperative symptomatic improvement. 3,5,10,14,15,17,18,20,21,24,27,29,30,[32][33][34] The pooled rate of hearing improvement was 14% (95% CI 9 -22, I 2 = 50.2%). The pooled rate of dysphagia and hoarseness improvement were 12% (95% CI 7 -21, I 2 = 54.2%) and 14% (95% CI 9 -20, I 2 = 14.6%), respectively.…”