Extracranial Lower Cranial Nerve Sheath Tumors

Abstract

Lower cranial nerve sheath tumors of the infratemporal fossa usually reach considerable size before diagnosis because of a naturally slow growth rate in this relatively silent location. The safe surgical removal of these tumors, based on superior control of the internal carotid artery, can be achieved through the use of contemporary lateral skull base techniques.

Endoscopic Management of Benign Tumors Extending Into the Infratemporal Fossa: A Two-Surgeon Transnasal Approach

“…The current preliminary report details the steps necessary to perform a resection of benign tumors extending into the ITF, with macroscopic resection possible in all cases, with no local recurrences seen, and with a relatively short follow‐up period. Tumors within the ITF are rare, making up less than 1% of head and neck tumors 11–13 . The surgical management of these lesions is difficult principally because of access to this area.…”

The Jugular Foramen Schwannomas: Review of the Large Surgical Series

“…In this study the most of clinical signs and symptoms are associated with otolaryngologic deficits (such as hearing loss, tinnitus, hoarseness, vertigo and swallowing difficulties); and with cerebellar disturbances (such as ataxia, nystagmus, dizziness). Because of nonspecific signs and symptoms of the disease, otolaryngologic evaluation of these patients is certain essential for differential diagnosis and for pre-and post-operative surgical outcome, and it must include a complete history and physical examination with special attention to all cranial nerves 11) .…”

“…MR scan with gadolinium enhancement can demonstrate the soft tissue details, vascular supply to the tumors, relationship of major vasculatures, patency of the internal jugular vein and its bulb 17) . The surgical management of these tumors should include control of the great vessels and adjacent lower cranial nerves 11) . Carotid and vertebral angiography and/or MR angiography is helpful to determine the vascularity of the tumor and it can evaluate the displacement of adjacent blood vessels and carotid system involvement.…”

“…Also, some authors may choose a single-stage operation but others may constitute two step operation with otorhinolaryngologist 4,6,24) . Most of authors prefer infratemporal fossa approach (ITFA) which provides the greatest exposure of the jugular foramen, carotid artery, and anterior temporal bone and it allows direct access to the posterior fossa 3,4,10,11,18,23,24) . It can be combined with translabyrinthine, retrosigmoid, transcochlear approaches for a large type B or D tumor which have anterior intracranial extension 10) .…”

Current management of head and neck schwannomas

“…Moreover, close observation and follow-up is an option in medically unstable and older individuals. The approach for resection is dictated by the location of the tumor, ranging from intratemporal fossa and other lateral skull base approaches for jugular foramen lesions to lateral cervical incisions that provide access to cervical vagal tumors [29]. A vocal cord medialization procedure is performed later to correct for hoarseness and aspiration [17,28].…”