Surgical treatment of dumbbell-shaped jugular foramen schwannomas

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Schwannomas of the jugular foramen are rare, comprising between 2 and 4% of intracranial schwannomas. The authors retrospectively analyzed their surgical experience with schwannomas of the lower cranial nerves that presented with intra- and extracranial extensions through an enlarged jugular foramen. The transcondylar suprajugular approach was used without sacrificing the labyrinth or the integrity of the jugular bulb. In this report the clinical and radiological features are discussed and complications are analyzed.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This retrospective study includes six patients (three women and three men, mean age 31.6 years) with dumbbell-shaped jugular foramen schwannomas that were surgically treated by the senior author during a 5.5-year period. One patient had undergone previous surgery elsewhere. Glossopharyngeal and vagal nerve deficits were the most common signs (appearing in all patients), followed by hypoglossal and accessory nerve deficits (66.6%). Two or more signs or symptoms were present in every patient. Three tumors presented with cystic degeneration. In four patients the jugular bulb was not patent on neuroimaging studies. The suprajugular approach was used in five patients; the origin of the tumor from the 10th cranial nerve could be defined in three of them. All lesions were completely resected. No death or additional postoperative cranial nerve deficits occurred in this series. Aspiration pneumonia developed in one patient. Preoperative deficits of the ninth and 10th cranial nerves improved in one third of the patients and half recovered mobility of the tongue. No recurrence was discovered during the mean follow-up period of 32.8 months.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>With careful, extensive preoperative evaluation and appropriate planning of the surgical approach, dumbbell-shaped jugular foramen schwannomas can be radically and safely resected without creating additional neurological deficits. Furthermore, recovery of function in the affected cranial nerves can be expected.</jats:p></jats:sec>

A Limited Approach to the Jugular Bulb: Anatomical Considerations in a Rare Jugular Foramen Tumour

“…The tumour showed marked enhancement but was not a vascular tumour thus eliminating the differential diagnosis of a glomus jugulare tumour. As confirmed by Kadri and Al Mefty [1], ''The choice of surgical approach is of vital importance for success. A safe exposure demands that the surgeon understand the microanatomy of the region to preserve the neurovascular structures.''…”

“…A safe exposure demands that the surgeon understand the microanatomy of the region to preserve the neurovascular structures.'' [1].…”

“…Schwannomas of the jugular foramen are rare tumours that represent between two and four percent of all intracranial schwannomas [1]. They are Schwann cell tumours that arise from the lower cranial nerves and are of anatomical interest due to their rarity.…”

Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

“…Kadri and Al-Mefty 44 describing a series of six dumbbell jugular foramen schwannomas reported that the tumor was completely resected in all patients with no additional cranial nerve deficits and that with a mean follow up of 32.8 months, two of the six patients with pre-operative IXth and Xth cranial nerve palsy attained significant improvement and two of four patients with preoperative hypoglossal nerve palsy completely recovered mobility of the tongue; in the same series, one of the two patients with hearing loss had significant improvement of that deficit, and a patient with facial palsy completely recovered nerve function. A patient with a sixth cranial nerve deficit completely recovered ocular motion.…”

Accessory Nerve Schwannoma Extending to the Foramen Magnum and Mimicking Glossopharyngeal Nerve Tumor—A Case and Review of Surgical Techniques

“…Modified classification system for jugular foramen schwannomas as propose by Bulsara and associates using only imaging studies to determine the surgical approach. the lesion is radically removed [21]. This approach is the most appropriate for our case considering the location of the lesion.…”