Surgical Management of Jugular Foramen Schwannomas

Abstract

Background: Resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve (CN) injury remains difficult. Reoperations in this vital region are associated with severe CN deficits. Methods: We performed a retrospective analysis at a tertiary neurosurgical center of patients who underwent surgery for JFSs between June 2007 and May 2020. We included nine patients (median age 60 years, 77.8% female, 22.2% male). Preoperative symptoms included hearing loss (66.6%), headache (44.4%), hoarseness (33.3%), dysphagia (44.4%), hypoglossal nerve palsy (22.2%), facial nerve palsy (33.3%), extinguished gag reflex (22.2%), and cerebellar dysfunction (44.4%). We observed Type A, B, C, and D tumors in 3, 1, 1, and 4 patients, respectively. A total of 77.8% (7/9) underwent a retrosigmoid approach, and 33.3% (3/9) underwent an extreme lateral infrajugular transcondylar (ELITE) approach. Gross total resection (GTR) was achieved in all cases. The rate of shunt-dependent hydrocephalus was 22.2% (2/9). No further complications requiring surgical intervention occurred during follow-up. The median follow-up time was 16.5 months (range 3–84 months). Conclusions: Considering the satisfying outcome, the GTR of JFSs is feasible in performing well-known skull base approaches. Additional invasive and complicated approaches were not needed. Radiosurgery may be an effective alternative for selected patients.

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

“…In most cases, only the distal part of the sigmoid sinus is exposed while the opening of JF is facilitated both by the bone erosion and the JF enlargement produced by the tumor growth. 1,3-7,12-20 This may be not necessary in type C of JFs and in all our cases. Thanks to this, it is not necessary to drill the temporal petrous bone, so the risk of VII cranial nerve damage is decreased.…”

“…Because of their low incidence and the clearly difficult anatomical features of the region, JFs correct management is still discussed in the literature. 1,3-7,12-20 We experienced and recommend ELJA. In this approach, the surgical position described increased space in the surgical field; it improves lateral posterior view; in addition, it limits VA rotation and atlas displacement.…”

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

“…Most operations were performed with the retrosigmoid approach (36.5%) combined with suboccipital craniotomy (23.2%), with the far-lateral approach (29.7%) combined with suboccipital craniotomy and cervical laminectomy (15%), or with the posterior approach combined with cervical laminectomy (26.9%). The extreme lateral infrajugular transcondylar–transtubercular exposure (ELITE) was performed in 16 patients (4.5%) [ 30 , 31 ], and the endoscopic transoral resection in 8 (2.3%) [ 32 , 33 , 34 ]. Jiang et al [ 11 ] also reported the use of occipitocervical fusion in 6 patients (1.7%) after cervical laminectomy and facetectomy.…”

“…Clinical pictures of CVJ schwannomas mirror their anatomy, with most patients experiencing headache and neck pain as primary symptoms [ 10 , 12 ]. The high frequency of sensory disturbances likely stems from the sensory nerve roots’ tumor origin, while other impairments are caused by tumors compressing contiguous structures, such as lower cranial nerves (hoarseness, speech disorders, hearing disturbance), cerebellum (ataxia), and brainstem/cervical spinal cord (motor disorders) [ 31 , 36 , 54 ]. Tongue atrophy is typical in hypoglossal schwannomas [ 40 ], while evident neck masses may be found in otherwise asymptomatic slow-growing C1–C2 tumors [ 55 ].…”

“…Surgical routes largely depended on tumor location and origin, with far-lateral, suboccipital, and retrosigmoid approaches preferred in the jugular foramen, foramen magnum, and hypoglossal canal tumors, while cervical laminectomy was frequently performed to better access C1–C2 tumors [ 10 , 12 , 31 , 36 ]. Tumors located in multiple compartments required combined skull base and spine approaches, such as the ELITE approach [ 30 , 31 ], to safely identify and dissect lesions from adjacent vascular and neural structures. The endoscopic transoral approach has also been reported by Crockard et al [ 32 ] and Zhang et al [ 33 , 34 ] as a viable route for the management of hypoglossal and cervical schwannomas.…”