Glossopharyngeal schwannoma, an uncommon posterior fossa tumor: Diagnostical and therapeutical aspects: A case report

Rapanà, Armando; Lamaida, E.; Bracale, C; Lepore, P.; Pizza, V.; Graziussi, G

doi:10.1016/s0303-8467(97)00016-4

Cited by 17 publications

(10 citation statements)

References 17 publications

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“…Our modified classification scheme facilitated improved preoperative planning. The evolution of surgical treatment of jugular foramen schwannomas has been slow 1,4,6,7,[10][11][12]16,19,[21][22][23][26][27][28][29]31,32,36,37,42,43,45,[48][49][50][51][52][53]56,57,60,62,64,[67][68][69][70][71][72]76,77,79 (Table 3). This is primarily due to the rarity of the lesion and the complexity of the critical neurovascular anatomy associated with these lesions.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system

Bulsara

Sameshima²,

Friedman

et al. 2008

JNS

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A dvAnces in microsurgical techniques and cranial base approaches have allowed access to areas of the brain once considered inaccessible. Despite these advances, however, the microsurgical resection of jugular foramen schwannomas continues to pose a formidable challenge. Fewer than 200 cases of schwannomas arising from the jugular foramen have been reported in the literature, a testament to the rarity of this tumor. 25,29,41,53,59,65,71,74 Experience has shown that the traditional suboccipital and transmastoid approaches do not provide adequate exposure of these lesions. Understanding and utilizing advanced skull base surgery techniques and concepts is essential for adequate resection of these tumors with CN preservation. We review the senior author's experience (T.F.) in the management of 53 jugular foramen schwannomas and propose a modified grading scheme to guide operative planning for these tumors. MethodsWe retrospectively reviewed all cases of jugular foramen schwannomas treated by the senior author Object. Due to the proximity and involvement of critical neurovascular structures, the resection of jugular foramen schwannomas can pose a formidable challenge. The authors review their experience in the microsurgical management of jugular foramen schwannomas and propose a modified grading scale to guide surgical management.Methods. All jugular foramen schwannoma cases treated by the senior author (T.F.) between 1980 and 2004 were retrospectively reviewed. The average age at presentation, surgical approach, tumor characteristics, cranial nerve (CN) deficits, and tumor recurrence rates were assessed. The authors present the following modified grading scale: Type A, intradural tumors; Type B, dumbbell-shaped tumors; and Type C, triple dumbbell tumors with a high cervical extension.Results. The authors treated jugular foramen tumors in 129 patients during the study period. Of these, 53 patients (41%) had jugular foramen schwannomas. The mean patient age was 52 years (range 14-74 years); there were 12 male and 41 female patients. The mean follow-up period was 8.4 years. Patients presented most commonly with deficits of the vagus nerve, followed by vestibular/cochlear nerve and glossopharyngeal nerve deficits. Gross-total resection of the tumor was achieved in 48 patients (90.5%). New postoperative paresis in a previously normal CN was not seen; however, worsening of preoperative CN deficits was frequently noted. The highest incidence occurred with the glossopharyngeal and vagus nerves (30%), with 26% of the deficits being permanent. There were no deaths related to surgery in this series. Three patients (5.7%) experienced tumor recurrence.Conclusions. The microsurgical resection of jugular foramen schwannomas carries a risk of worsening preoperative CN deficits; however, these are often transient. Based on their experience, the authors have formulated a grading scale that predicts the optimal surgical approach to these lesions. Considerable technical training and microneuroanatomical knowledge of the region is requi...

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Section: Discussionmentioning

confidence: 99%

Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system

Bulsara

Sameshima²,

Friedman

et al. 2008

JNS

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“…11 The tumors are much more commonly right sided, and there tends to be a slight male preponderance. 8 To our knowledge, this is the first reported case of a CN IX schwannoma in the pediatric literature.…”

Section: Discussionmentioning

confidence: 72%

“…Indeed, 73-90% of patients with CN IX schwannomas will present with hearing loss as the sole or main neurological sign of the tumor. 8,10 This rate of hearing loss approaches and even exceeds known rates of hearing loss at presentation for vestibular schwannomas of 75-90%. 13 In contrast, in a comprehensive review of previously reported cases, Rapanà et al, 8 found that 29% of patients with CN IX schwannomas presented with hoarseness and 19% with decreased gag reflex, signs that would more commonly be expected from CN IX dysfunction.…”

Section: Discussionmentioning

confidence: 88%

“…Of the nonvestibular schwannomas, trigeminal nerve schwannomas are the most common, comprising 0.8-8% of all intracranial schwannomas and 0.1-0.36% of all intracranial tumors. 8,9,13 Cranial nerve IX schwannomas are an even rarer entity, and only ~ 40 cases were reported in the literature at the time of this publication. [1][2][3]5,6,[9][10][11][12] Most of these tumors present in the 3rd-5th decade of life.…”

Section: Discussionmentioning

confidence: 99%

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Glossopharyngeal schwannoma in childhood

Thomas

Bank²,

Myseros

2008

PED

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Glossopharyngeal (that is, cranial nerve IX) schwannomas are extremely rare nerve sheath tumors that frequently mimic the more common vestibular schwannoma in their clinical as well as radiographic presentation. Although rare in adults, this tumor has not been reported in a child. The authors report the case of a 10-year-old boy who presented with several months of unilateral hearing loss. He was found to have a large right cerebellopontine angle tumor. Given the boy's primary complaint of hearing loss and the appearance of the lesion on imaging, the tumor was initially believed to be a schwannoma of the vestibular nerve. It was found intraoperatively, however, to originate from the glossopharyngeal nerve. To the authors' knowledge, this is the first reported case of a glossopharyngeal schwannoma in a child.

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“…A total of 42 cases of glossopharyngeal schwannomas were identified5–20, 23–26, 32–37 (Table II). The age range of affected patients was 15–86, with an average age of presentation at 39.8 (±15.1) 73% (32/44) of cases occurred in patients in their second and fourth decade of life (Fig.…”

Section: Resultsmentioning

confidence: 99%

Glossopharyngeal schwannomas: A 100 year review

Vorasubin

Mafee

et al. 2008

The Laryngoscope

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Glossopharyngeal schwannomas usually present with vestibulocochlear rather than glossopharyngeal symptoms, likely due to CNVIII compression and displacement by tumor, which can be better appreciated with modern imaging. The tumor's location posterior and medial to CNVIII combined with the complex CNVIII tonotopic organization may account for the preferential mid-frequency hearing loss seen in these patients.

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Glossopharyngeal schwannoma, an uncommon posterior fossa tumor: Diagnostical and therapeutical aspects: A case report

Cited by 17 publications

References 17 publications

Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system

Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system

Glossopharyngeal schwannoma in childhood

Glossopharyngeal schwannomas: A 100 year review

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