Lower Cranial Nerve Function Following Jugular Foramen Tumor Resection

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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Anatomy involved in the jugular foramen approach for jugulotympanic paraganglioma resection

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.2.6 ◽

2004 ◽

Vol 17 (2) ◽

pp. 41-44 ◽

Cited By ~ 15

Author(s):

Michelle M. Inserra ◽

Markus Pfister ◽

Robert K. Jackler

Keyword(s):

Carotid Artery ◽

Facial Nerve ◽

Cranial Nerve ◽

Jugular Foramen ◽

Jugular Bulb ◽

Nerve Function ◽

Risk Of Injury ◽

Increased Risk ◽

Cranial Nerve Function ◽

Special Circumstances

The goal in paraganglioma resection is to allow adequate exposure to remove the lesion while preserving cranial nerve function. Knowledge of the anatomy of the jugular foramen is crucial to this endeavor. In this report the authors describe a jugular foramen approach for the resection of glomus jugulare tumors in cases in which rerouting of the facial nerve can be avoided. This approach provides adequate exposure of the jugular bulb for many jugulotympanic paragangliomas without increased risk of injury to the facial nerve. In addition, special circumstances surrounding intracranial and carotid artery involvement are briefly discussed.

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Recovery of Lower Cranial Nerve Function after Surgery for Medullary Brainstem Tumors

Neurosurgery ◽

10.1227/01.neu.0000144782.39430.12 ◽

2005 ◽

Vol 56 (1) ◽

pp. 74-78 ◽

Cited By ~ 12

Author(s):

George I. Jallo ◽

Tania Shiminski-Maher ◽

Linda Velazquez ◽

Rick Abbott ◽

Jeff Wisoff ◽

...

Keyword(s):

Cranial Nerve ◽

Radical Surgery ◽

Motor Deficits ◽

Nerve Function ◽

Surgical Morbidity ◽

Lower Cranial Nerve ◽

Cranial Nerve Dysfunction ◽

Cranial Nerve Function ◽

Nerve Recovery ◽

Brainstem Tumors

Abstract OBJECTIVE: Although optimal treatment for intrinsic focal tumors of the medulla remains controversial, many surgeons advocate radical surgery for patients with these tumors. Postoperative surgical morbidity may include loss of lower cranial nerve function and significant motor deficits. Recovery of lower cranial nerve dysfunction after radical surgery has not been reported previously. METHODS: Forty-one children and adolescents with tumors involving the medulla underwent operations between 1986 and 1997. Nineteen (46%) of these patients experienced loss of lower cranial nerve function requiring tracheostomy, ventilator support, and feeding gastrostomy. A retrospective analysis of this patient population and the time to cranial nerve recovery was undertaken. RESULTS: Thirteen (68%) of the 19 patients with loss of lower cranial nerve function had full recovery of lower cranial nerve function. Two patients (11%) have had significant improvement in their lower cranial nerve function, and four patients (21%) have remained without lower cranial nerve function. CONCLUSION: Lower cranial dysfunction is common after surgery for intrinsic medullary tumors. However, the majority of patients who require tracheostomy or gastrostomy tubes will recover cranial nerve function.

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Microsurgical Management of Jugular Foramen Schwannomas

Neurosurgery ◽

10.1227/neu.0b013e3182770e74 ◽

2012 ◽

Vol 72 (1) ◽

pp. 42-46 ◽

Cited By ~ 20

Author(s):

Cara L. Sedney ◽

Yoichi Nonaka ◽

Ketan R. Bulsara ◽

Takanori Fukushima

Keyword(s):

Cranial Nerve ◽

Tumor Resection ◽

Jugular Foramen ◽

Control Analysis ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

In Series ◽

Case Control Analysis ◽

Cranial Nerve Preservation ◽

Modern Era

Abstract BACKGROUND: Jugular foramen schwannomas are uncommon and surgically challenging lesions. OBJECTIVE: To determine the importance of surgical technique on morbidity and recurrence of jugular foramen schwannomas. METHODS: A retrospective review and case-control analysis of a single-senior-surgeon series of 81 patients with surgically treated jugular foramen schwannomas was performed, focusing on operative technique. Patients undergoing an aggressive, total tumor resection (series 1) were compared with those undergoing more conservative resection focusing on preserving the pars nervosa (series 2). RESULTS: There was a statistically significant (P = .04) decrease in permanent deficits of the cranial nerve 9/10 complex with a conservative technique. Recurrence was seen in 3 patients (5.7%) in series 1 and in 3 patients (10.7%) in series 2 (P = .36). Recurrence was treated with reoperation in 1 patient, radiation in 1 patient, and observation in the others. CONCLUSION: Although radical gross total resection is desirable, it is not optimal for cranial nerve preservation in patients with jugular foramen schwannomas. A more conservative approach resulted in a statistically significant decrease in lower cranial nerve deficits. There was a nonstatistically significant trend toward increasing recurrence, which may be treated with multiple modality therapy in the modern era.

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Metachronous Skull Base Paraganglioma Surgical Management: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab268 ◽

2021 ◽

Author(s):

Walid Ibn Essayed ◽

Ossama Al-Mefty

Keyword(s):

Head And Neck ◽

Cranial Nerve ◽

Hormone Secretion ◽

Jugular Bulb ◽

Preoperative Embolization ◽

Nerve Function ◽

Lower Cranial Nerve ◽

Tumor Patient ◽

Increased Risk ◽

Cranial Nerve Function

Abstract Paragangliomas (PGLs) are benign hypervascular tumors that can develop in head and neck at different locations, primarily in the carotid bifurcation, jugular bulb, tympanic plexus, and vagal ganglia.1 Different gene mutations have been linked to the familial inherited forms, which can represent approximately 30% of all PGLs.1,2 These are classified into 5 different clinical syndromes: PGL 1 to 5.1 These patients have increased risk for synchronous and metachronous lesions requiring an extensive work-up for hormone secretion and other associated neoplasms, as well as attentive follow-up for lifelong management.1,3 Surgical resection is the best treatment option as it can be curative when the resection is total.2-4 Preservation of the lower cranial nerve function is central to the management of head and neck PGLs, given the gravity of bilateral injuries.3 Irradiation therapy should be considered if the risk for bilateral lower cranial nerve injuries is high.5 Surgically, intrabulbar resection with preservation of the medial wall of the jugular bulb protects the lower cranial nerve function.3 Other technical finesses, including maintaining the facial nerve in its bony fallopian canal (facial bridge), avoiding carotid artery sacrifice, preservation of the ear canal, and preoperative embolization, contributed markedly to outcome improvement.2,3 We report a case of a 34-yr-old male with PGL 3 with a left glomus jugulare tumor that recurred and a right carotid body tumor. Patient consented to surgery and photography. Image at 3:44 republished from Al-Mefty and Teixeira,3 with permission from JSNPG.

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