Jugular Foramen Schwannomas: Diagnosis, Management, and Outcomes

Wilson, Matthew A.; Hillman, Todd A.; Wiggins, Richard H.; Shelton, Clough

doi:10.1097/01.mlg.0000172196.76865.a1

Cited by 60 publications

(66 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The frequency of this type has varied from 8.6% to 50% of jugular foramen schwannomas in different series. 8,19,26,30,31,40 The origin, radiological characteristics, and pathological behavior of jugular foramen schwannoma have been reviewed elsewhere. 5,8,18,26,31,36 In the nonpathological jugular foramen, CNs IX-XI course superomedial to the jugular bulb.…”

Section: Discussionmentioning

confidence: 99%

Suprajugular extension of the retrosigmoid approach: microsurgical anatomy

Matsushima

Kohno

Komune

et al. 2014

JNS

View full text Add to dashboard Cite

Object Jugular foramen tumors often extend intra- and extracranially. The gross-total removal of tumors located both intracranially and intraforaminally is technically challenging and often requires a combined skull base approach. This study presents a suprajugular extension of the retrosigmoid approach directed through the osseous roof of the jugular foramen that allows the removal of tumors located in the cerebellopontine angle with extension into the upper part of the foramen, with demonstration of an illustrative case. Methods The cerebellopontine angles and jugular foramina were examined in dry skulls and cadaveric heads to clarify the microsurgical anatomy around the jugular foramen and to define the steps of the suprajugular exposure. Results The area drilled in the suprajugular approach is inferior to the acoustic meatus, medial to the endolymphatic depression and surrounding the superior half of the glossopharyngeal dural fold. Opening this area exposed the upper part of the jugular foramen and extended the exposure along the glossopharyngeal nerve below the roof of the jugular foramen. In the illustrative case, a schwannoma originating from the glossopharyngeal nerve in the cerebellopontine angle and extending below the roof of the jugular foramen and above the jugular bulb was totally removed without any postoperative complications. Conclusions The suprajugular extension of the retrosigmoid approach will permit removal of tumors located predominantly in the cerebellopontine angle but also extending into the upper part of the jugular foramen without any additional skull base approaches.

show abstract

Section: Discussionmentioning

confidence: 99%

Suprajugular extension of the retrosigmoid approach: microsurgical anatomy

Matsushima

Kohno

Komune

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…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.…”

mentioning

confidence: 99%

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

Bulsara

Sameshima²,

Friedman

et al. 2008

JNS

View full text Add to dashboard Cite

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...

show abstract

“…It is believed that the diagnosis and nerve origin can be determined by the initial symptoms and the grade of dysfunction of the nerve, especially when compared with adjacent nerves. This connection gives rise to the classic descriptions of the different syndromes affecting the lower cranial nerves 2,5,8,9 including descriptions by Vernet (involvement of the ninth, 10th, and 11th cranial nerves), Schmidt (the 10th and 11 th nerve), Collet-Sicard (9th, 10 th , 11th and 12th nerves), Jackson (the 10th, 11th, and 12th nerves), and Tapia (the 10th and 11 th , 12th nerves and symphathetic), Villeret (9 th ,10 th ,12 th and symphathetic) as well as a combination of these syndromes. Cases in the study can be named as Collet-Sicard plus VIII nerve syndrome!…”

Section: Discussionmentioning

confidence: 90%

“…The early symptoms of tumors originated in the jugular foramen are, in most cases, conductive hearing loss and tinnitus. Other lesions may cause paralysis of the lower cranial pairs as a first symptom 4 1,2,5,8 . It is believed that the diagnosis and nerve origin can be determined by the initial symptoms and the grade of dysfunction of the nerve, especially when compared with adjacent nerves.…”

Section: Discussionmentioning

confidence: 99%