Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part III: Lower cranial nerve schwannomas, jugular foramen (CN IX, X, XI) and hypoglossal schwannoma (XII)

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

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Jugular Foramen Tumors

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1050 ◽

2011 ◽

Vol 3 (1) ◽

pp. 15-23 ◽

Cited By ~ 1

Author(s):

C Rayappa

Keyword(s):

Skull Base ◽

Cranial Nerve ◽

Skull Base Surgery ◽

Cranial Nerves ◽

Radical Resection ◽

Jugular Foramen ◽

Cranial Base ◽

Lower Cranial Nerve ◽

Radiological Features ◽

Lower Cranial Nerves

ABSTRACT Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. These tumors have characteristic radiological features. Radical resection of these tumors with preservation of the lower cranial nerves is the treatment of choice. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge.

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Jugular foramen tumors: diagnosis and treatment

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.2.5 ◽

2004 ◽

Vol 17 (2) ◽

pp. 31-40 ◽

Cited By ~ 77

Author(s):

Ricardo Ramina ◽

Joao Jarney Maniglia ◽

Yvens Barbosa Fernandes ◽

Jorge Rizzato Paschoal ◽

Leopoldo Nizan Pfeilsticker ◽

...

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Cranial Nerve ◽

Cranial Nerves ◽

Jugular Foramen ◽

Lower Cranial Nerve ◽

Nerve Paralysis ◽

Great Auricular Nerve ◽

Csf Leakage ◽

Nerve Anastomosis

Object Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes. Methods The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004. All patients underwent surgery with a multidisciplinary method combining neurosurgical and ear, nose, and throat techniques. Preoperative embolization was performed for paragangliomas and other highly vascularized lesions. To avoid postoperative cerebrospinal fluid (CSF) leakage and to improve cosmetic results, the surgical defect was reconstructed with specially developed vascularized flaps (temporalis fascia, cervical fascia, sternocleidomastoid muscle, and temporalis muscle). A saphenous graft bypass was used in two patients with tumor infiltrating the internal carotid artery (ICA). Facial nerve reconstruction was performed with grafts of the great auricular nerve or with 12th/seventh cranial nerve anastomosis. Residual malignant and invasive tumors were irradiated after partial removal. The most common tumor was paraganglioma (58 cases), followed by schwannomas (17 cases) and meningiomas (10 cases). Complete excision was possible in 45 patients (77.5%) with paragangliomas and in all patients with schwannomas. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 10 patients (10%), but it was transient in four cases. Postoperative facial and cochlear nerve paralysis occurred in eight patients (8%); spontaneous recovery occurred in three of them. In the remaining five patients the facial nerve was reconstructed using great auricular nerve grafts (three cases), sural nerve graft (one case), and hypoglossal/facial nerve anastomosis (one case). Four patients (4%) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation. Conclusions Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.

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Endoscopic Removal of Skull Base Chordoma Type III through Single Skull Base Approach: Our Early Experience

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i1.42926 ◽

2019 ◽

Vol 9 (1) ◽

pp. 57-63

Author(s):

Shamsul Alam ◽

Mohammad Sujan Sharif ◽

Rathin Haldar ◽

Anil Chaudhury ◽

Abdullah Al Mahbub ◽

...

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Cranial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Lower Cranial Nerve ◽

Base Approach ◽

Type Iii ◽

Skull Base Approach ◽

Skull Base Chordoma

Introduction: Skull base chordomas present with headache, commonly VI cranial nerve palsy or sometimes with lower cranial nerve involvement.Sometimes in neglected case it presents with complete blindness and facial nerve palsy. Case presentation: A 60-year old man presented with headache,visual disturbance progressing to blindness and facial nerve palsy. At first, radiological imaging showed large tumor which eroded his clivus, sella floor and involved both cavernous carotid more on left side,both ethmoid sinus,middle cranial fossa entension with transdural extension posteriorly. Conclusion: Patients who present with complete blindness and facial nerve palsy, endoscopic excision in a single skull base approach of a skull base chordoma type III is challenging and who developed visual improvement following surgery, has been highlighted in this report. Bang. J Neurosurgery 2019; 9(1): 57-63

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

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v18i2.12015 ◽

2012 ◽

Vol 18 (2) ◽

pp. 183-192

Author(s):

Forhad H Chowdhury ◽

Mohammod R Haque ◽

Mahmudul Hasan

Keyword(s):

Cranial Nerve ◽

Cranial Nerves ◽

Young Male ◽

Carotid Bifurcation ◽

Short Review ◽

Jugular Foramen ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies ◽

Cervical Approach ◽

High Cervical

Introduction: Jugular foramen tumor is a rare tumor. Jugular foramen schwannoma is rarer. This type of tumor may present in combination of different cranial nerve palsies in the form of different syndromes or may also be diagnosed incidentally. Management of such tumor is not straight forward.Case reports: Two young male presented with headache, vomiting, gait instability, right sided hearing loss. Clinically they had different cranial nerves dysfunction. Imaging showed jugular foramen tumor extending from posterior fossa to almost common carotid bifurcation at neck in both cases. Near total microsurgical excisions of the tumor were done through retrosigmoid suboccipital plus transmastoid high cervical approach with facial nerve mobilization in one case and without mobilization in other case. In case 1 combination of lower cranial nerve palsies is unique with inclusion of VIII nerve and that does not belong to any of the jugular foramen syndromes (i.e. Vernet, Collet- Sicard, Villaret, Tapia, Schmidt, and Jackson). Here IX, X, XI, XII and VIII cranial palsies was present (i.e.Collet-Sicard syndrome plus VIII nerve syndrome!). In the second case there was IX & X dysfunction with VIII dysfunction. We also went through the short review of the literature here DOI: http://dx.doi.org/10.3329/bjo.v18i2.12015 Bangladesh J Otorhinolaryngol 2012; 18(2): 183-192

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Internal carotid artery aneurysm in skull base osteomyelitis: does the pattern of cranial nerve involvement matter?

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001202 ◽

2018 ◽

Vol 132 (10) ◽

pp. 929-931

Author(s):

F Hassannia ◽

S D Carr ◽

E Yu ◽

J A Rutka

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Cranial Nerve ◽

Internal Carotid ◽

Artery Aneurysm ◽

Lower Cranial Nerve ◽

Skull Base Osteomyelitis ◽

Carotid Artery Aneurysm ◽

Nerve Involvement

AbstractObjectiveCarotid artery aneurysm is a potentially fatal complication of skull base osteomyelitis. It is important to know the warning signs for this complication, as early diagnosis is of great importance. This report aimed to determine whether the pattern of cranial nerve involvement may predict the occurrence of aneurysm involving the internal carotid artery in skull base osteomyelitis.MethodsTwo diabetic patients with skull base osteomyelitis were incidentally diagnosed with pseudo-aneurysm of the petrous internal carotid artery on follow-up magnetic resonance imaging. They presented with lower cranial nerve palsy; however, facial nerve function was almost preserved in both cases. Computed tomography angiography confirmed aneurysms at the junction of the horizontal and vertical segments of the petrous carotid artery.ResultsInternal carotid artery trapping was conducted using coil embolisation. Post-coiling magnetic resonance imaging demonstrated no procedure-related complications. Regular follow up has demonstrated that patients’ symptoms are improving.ConclusionOne should be mindful of this potentially fatal complication in skull base osteomyelitis patients with lower cranial nerve palsies, with or without facial nerve involvement, especially in the presence of intracranial thromboembolic events or Horner's syndrome.

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Skull base infection presenting with multiple lower cranial nerve palsies

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2009.04.001 ◽

2010 ◽

Vol 31 (5) ◽

pp. 376-380 ◽

Cited By ~ 25

Author(s):

Harriet Patmore ◽

Ala Jebreel ◽

Sandeep Uppal ◽

Chris H. Raine ◽

Paul McWhinney

Keyword(s):

Skull Base ◽

Cranial Nerve ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies

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Cranial Nerve Preservation and Outcomes after Stereotactic Radiosurgery for Jugular Foramen Schwannomas

Neurosurgery ◽

10.1227/01.neu.0000279726.90650.6d ◽

2007 ◽

Vol 61 (1) ◽

pp. 76-81 ◽

Cited By ~ 37

Author(s):

Juan J. Martin ◽

Douglas Kondziolka ◽

John C. Flickinger ◽

David Mathieu ◽

Ajay Niranjan ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Cranial Nerve ◽

Gamma Knife Radiosurgery ◽

Jugular Foramen ◽

Tumor Control ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

Cranial Nerve Function ◽

Cranial Neuropathies ◽

Cranial Nerve Preservation

Abstract OBJECTIVE Jugular foramen region schwannomas are rare intracranial tumors that usually present with multiple lower cranial nerve deficits. For some patients, complete surgical resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery is a minimally invasive alternative or adjunct to microsurgery for such tumors. We reviewed our clinical and imaging outcomes after patients underwent gamma knife radiosurgery for management of jugular foramen schwannomas. METHODS Thirty-four patients with 35 tumors (one patient had bilateral tumors) underwent radiosurgery between May 1990 and December 2005. Twenty-two patients had previous microsurgical resection and all patients experienced various cranial neuropathies. A median of six isocenters were used. Median marginal and maximum doses were 14 and 28 Gy, respectively. RESULTS None of the patients were lost to evaluation and the mean duration of follow-up was 83 months. Tumors regressed in 17 patients, remained stable in 16, and progressed in two. Five- and 10-year actuarial control rates were 97 and 94%, respectively. Preexisting cranial neuropathies improved in 20% and remained stable in 77% after radiosurgery. One patient worsened. The function of all previous intact nerves was preserved after radiosurgery. CONCLUSION Stereotactic radiosurgery proved to be a safe and effective management for newly diagnosed or residual jugular foramen schwannomas. Long-term tumor control rates and stability or improvement in cranial nerve function was confirmed.

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