Importance of Preserved Periosteum Around Jugular Foramen Neurinomas for Functional Outcome of Lower Cranial Nerves

Sutiono, Agung Budi; Kawase, Takeshi; Tabuse, Masanao; Kitamura, Yohei; Arifin, Muh Zafrullah; Horiguchi, Takashi; Yoshida, Kazunari

doi:10.1227/neu.0b013e31822a19a3

Cited by 19 publications

(22 citation statements)

References 17 publications

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“…Anatomical studies 1,17,19 have shown that inside the JF the lower CNs are enveloped in a common sheath of the periosteal dura and this makes it difficult to separate them from each other at this segment. Thus, approaching the intraforaminal compartment of the JF tumors from outside (transjugular approach), which necessitates opening of this sheath, endangers the lower CNs.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, if the sheath is not opened, some tumor residue might be left along the JF that carries a high risk of recurrence. 17 For instance, in 1 study of the conservative approach, 17 all of the 6 schwannomas originating from the jugular pocket recurred. Using the endoscope helps to visualize the tumor remnant in the JF from "inside toward outside" and obviates the need to drill the canal of the JF completely and to open the dural sheath of the JF that adds to the risk of lower CN injury.…”

Section: Discussionmentioning

confidence: 99%

“…It covers the intrajugular process, the glossopharyngeal recess, and the CN meatus. 11,17,19 The dural covering of the JF has a defect called the jugular pocket, through which the lower CNs exit the cranium. 11,17 The glossopharyngeal meatus is located anterosuperomedially and is separated by a dural septum ( Fig.…”

Section: Meningeal Structuresmentioning

confidence: 99%

“…1 right) from the vagal meatus that contains the vagus and accessory nerves. 1,11,17,19 Inside the canal of the JF the lower CNs are tightly enveloped in a common sheath of periosteal dura that gradually transforms into epineurium. 17 …”

Section: Meningeal Structuresmentioning

confidence: 99%

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Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors

Samii

Alimohamadi

Gerganov

2016

JNS

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OBJECT Removal of jugular foramen (JF) tumors usually requires extensive skull base approaches and is frequently associated with postoperative morbidities such as lower cranial nerve injury. The endoscope-assisted retrosigmoid infralabyrinthine approach is a relatively new approach to tumors extending into the bony canal of the JF. The authors present their experience with this approach. METHODS The endoscope-assisted retrosigmoid infralabyrinthine approach was used in 7 patients, including 5 with schwannomas and 2 with paragangliomas. The access to the tumor, extent of its removal, postoperative neurological outcome, and approach-related morbidities were evaluated. RESULTS Two patients had a history of previous partial tumor removal, and 1 was treated by embolization followed by two courses of Gamma Knife radiosurgery. In this latter patient near-total resection was achieved. Gross-total resection was possible in the remaining 6 patients. Five patients benefited from endoscopic assistance: in 2 patients it showed a tumor remnant after microscopic tumor removal, while in 3 patients it allowed safe removal of the intraforaminal tumor by visualizing the surrounding structures. No permanent neurological deficit was observed after the operation. Two patients presenting with swallowing disturbance had temporary postoperative worsening that improved later. One patient developed CSF leakage that was managed with a lumbar drain. CONCLUSIONS This study shows that the judicious application of the endoscope-assisted retrosigmoid infralabyrinthine approach is safe and effective for removal of the schwannomas extending into the JF and selected paragangliomas without significant luminal invasion of the sigmoid-jugular system.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Meningeal Structuresmentioning

confidence: 99%

Section: Meningeal Structuresmentioning

confidence: 99%

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Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors

Samii

Alimohamadi

Gerganov

2016

JNS

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“…FN and LCNs preservation Almost one to two thirds of patients would present with new and worsen dysfunction immediately after operation [3,5,7,34,36,38,50,51,58,63]. The injury to cranial nerves can happen during exposure and resection of the tumor.…”

Section: Surgical Approachesmentioning

confidence: 99%

Microsurgical management of primary jugular foramen meningiomas: a series of 22 cases and review of the literature

Tang

Zhang

et al. 2016

Neurosurg Rev

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This study summarized clinical manifestations, surgical management, histological grading, and long-term outcome of jugular foramen meningiomas (JFMs). Retrospective study was performed in 22 consecutive patients with primary JFMs from January 2004 to October 2010, enrolling 10 men and 12 women with average age of 39.4 (14-57 years). The most common initial symptom is hearing disorder, followed by lower cranial nerve dysfunctions. The tumor was classified into type I (intracranial) in 1, type II (intracranial) in 15, type IV (intracranial-extracranial) in 6, and none type III (extracranial). Surgical approaches mainly included retrosigmoid in 7, far lateral in 10, and juxtacondylar in 5, with some variations. The gross total resection was achieved in 15 cases and subtotal resection in 7. Fourteen patients (63.6 %) developed new or worse neurological deficits immediately after operation, of whom 11 (78.6 %) got alleviation. Postoperatively, keeping airway patency and prevention from aspiration pneumonia is very important. Nasotracheal intubation is much more tolerated than orotracheal intubation for postoperative patient management. WHO grade 2 was found in four cases (18.2 %) and grade 3 in one. During the average time of follow-up in 83.2 months, only one (grade 3) died of tumor regrowth 20 months after surgery and radiosurgery. Five of 17 patients of grade 1 developed tumor regrowth. Radiosurgery provides a good tumor control for tumor regrowth in grade 1, or postoperative grade 2 tumor. In conclusion, JFMs has a favorable long-term overall survival; however, neurological preservation is still challenging, especially low cranial nerves.

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Optimal treatment of jugular foramen schwannomas: long-term outcome of a multidisciplinary approach for a series of 29 cases in a single institute

et al. 2017

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Importance of Preserved Periosteum Around Jugular Foramen Neurinomas for Functional Outcome of Lower Cranial Nerves

Abstract: For LCN preservation, the periosteal layer covering the cranial nerves must be left intact except in patients with a subarachnoid tumor. To prevent tumor regrowth, postoperative gamma knife treatment is recommended in tumors with an MIB-1 greater than 3%.

Cited by 19 publications

References 17 publications

Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors

Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors

Microsurgical management of primary jugular foramen meningiomas: a series of 22 cases and review of the literature

Optimal treatment of jugular foramen schwannomas: long-term outcome of a multidisciplinary approach for a series of 29 cases in a single institute

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