Microsurgical Management of Jugular Foramen Schwannomas

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.

Download Full-text

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.

Download Full-text

Hypofractionated Robotic Stereotactic Radiosurgery for Vagal Paragangliomas: A Novel Treatment Strategy for Cranial Nerve Preservation

Otolaryngology ◽

10.1177/0194599820910150 ◽

2020 ◽

Vol 162 (6) ◽

pp. 897-904

Author(s):

Anne K. Maxwell ◽

Gautam U. Mehta ◽

Thomas Muelleman ◽

Zachary R. Barnard ◽

Thomas Hartwick ◽

...

Keyword(s):

Side Effects ◽

Stereotactic Radiosurgery ◽

Cranial Nerve ◽

Tumor Resection ◽

Tumor Control ◽

Subtotal Resection ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

Cranial Nerve Preservation ◽

Vagal Function

Objective To provide the first description of hypofractionated stereotactic radiosurgery (SRS) and evaluate tumor control and safety for vagal paragangliomas (VPs), which begin at the skull base but often have significant extracranial extension. Study Design Retrospective chart review. Setting Tertiary-referral neurotology and neurosurgery practice. Subjects and Methods Five VPs in 4 patients (all male, ages 15-56 years) underwent SRS between 2010 and 2018. Outcome measures included tumor dimensions on serial imaging, cranial nerve function, and radiation side effects. Results CyberKnife hypofractionated SRS was performed. The prescription dose was 24 or 27 Gy (maximum dose 33.4 Gy; range, 29.3-35.5 Gy) delivered in 3 equal fractions. The mean isodose line was 79% (range, 76%-82%). Four VPs were treated primarily, and 1 tumor underwent SRS to treat regrowth 2 years after microsurgical subtotal resection via the modified infratemporal fossa approach. The treatment volume ranged from 8.81 to 86.3 cm3 (mean, 35.7 cm3). All demonstrated stable size (n = 3) or regression (n = 2) at last follow-up, 63 to 85 months after SRS (mean, 76 months). One patient had stable premorbid vocal fold paralysis from a prior ipsilateral glomus jugulare tumor resection. All others demonstrated normal vagal function following SRS. Treatment-related side effects, including dysgeusia (n = 1), mucositis (n = 1), and neck soft-tissue edema (n = 2), were self-limited. Conclusions Hypofractionated SRS appears to be both safe and effective for treating VPs, including large-volume and predominantly extracranial tumors, while preserving vagal function. SRS should be considered as a cranial nerve preservation option, especially in settings of contralateral lower cranial nerve deficits or in those with multiple paragangliomas risking both vagal nerves.

Download Full-text

Neuroendocrine Carcinoma of the Jugular Foramen

Ear Nose & Throat Journal ◽

10.1177/014556130808700209 ◽

2008 ◽

Vol 87 (2) ◽

pp. 86-91 ◽

Cited By ~ 2

Author(s):

John P. Leonetti ◽

Mobeen A. Shirazi ◽

Sam Marzo ◽

Douglas Anderson

Keyword(s):

Neuroendocrine Carcinoma ◽

Vocal Fold ◽

Cranial Nerves ◽

Intensity Modulated Radiation Therapy ◽

Jugular Foramen ◽

Concurrent Chemotherapy ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

Pathologic Features ◽

Cranial Nerve Preservation

We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.

Download Full-text

Lower Cranial Nerve Function Following Jugular Foramen Tumor Resection

Otolaryngology ◽

10.1177/0194599811415823a277 ◽

2011 ◽

Vol 145 (2_suppl) ◽

pp. P218-P219

Author(s):

Ryan G. Porter ◽

David Chan ◽

Vijay M. Ravindra

Keyword(s):

Cranial Nerve ◽

Tumor Resection ◽

Jugular Foramen ◽

Nerve Function ◽

Lower Cranial Nerve ◽

Cranial Nerve Function

Download Full-text

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

Download Full-text

Cranial Nerve Preservation in Surgery for Large Acoustic Neuromas

Skull Base ◽

10.1055/s-2004-828699 ◽

2004 ◽

Vol 14 (2) ◽

pp. 85-90 ◽

Cited By ~ 17

Author(s):

J. Thomas Roland ◽

Andrew J Fishman ◽

John G Golfinos ◽

Noel Cohen ◽

George Alexiades ◽

...

Keyword(s):

Cranial Nerve ◽

Nerve Preservation ◽

Acoustic Neuromas ◽

Cranial Nerve Preservation

Download Full-text

Cranial Nerve Preservation in Lesions of the Jugular Fossa

Otolaryngology ◽

10.1177/019459989110500509 ◽

1991 ◽

Vol 105 (5) ◽

pp. 687-693 ◽

Cited By ~ 43

Author(s):

C. Gary Jackson ◽

Roberto A. Cueva ◽

Britt A. Thedinger ◽

Michael E. Glasscock

Keyword(s):

Cranial Nerve ◽

Nerve Preservation ◽

Jugular Fossa ◽

Cranial Nerve Preservation

Download Full-text

Late Pseudo-Exacerbation of Myasthenia Gravis Due to Ectopic Thymoma Invading Lower Cranial Nerves

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100030018 ◽

1990 ◽

Vol 17 (1) ◽

pp. 46-48 ◽

Cited By ~ 7

Author(s):

Gregg MacLean ◽

Alan Guberman ◽

Antonio Giulivi

Keyword(s):

Myasthenia Gravis ◽

Cranial Nerve ◽

Cranial Nerves ◽

Jugular Foramen ◽

Lower Cranial Nerve ◽

Cervical Mass ◽

Ectopic Thymoma ◽

Cranial Nerve Palsies ◽

Lower Cranial Nerves ◽

Repeated Aspiration

ABSTRACT:Dysarthria, dysphagia and repeated aspiration in a 54-year-old woman diagnosed and treated for myasthenia gravis 7 years earlier were initially thought to represent a late exacerbation of myasthenia. A cervical mass invading the jugular foramen and causing multiple lower cranial nerve palsies was biopsied and found to represent invasive ectopic thymoma.

Download Full-text

Endoscopic Endonasal Approach to the Ventral Jugular Foramen: Anatomical Basis, Technical Considerations, and Clinical Series

Operative Neurosurgery ◽

10.1093/ons/opx014 ◽

2017 ◽

Vol 13 (4) ◽

pp. 482-491 ◽

Cited By ~ 7

Author(s):

Francisco Vaz-Guimaraes ◽

Ana Carolina I. Nakassa ◽

Paul A. Gardner ◽

Eric W. Wang ◽

Carl H. Snyderman ◽

...

Keyword(s):

Tumor Resection ◽

Jugular Foramen ◽

Cerebrospinal Fluid Leakage ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Lower Cranial Nerve ◽

Presenting Symptoms ◽

Anatomical Basis ◽

Clinical Series

Abstract BACKGROUND: Surgical exposure of the jugular foramen (JF) is challenging given its complex regional anatomy and proximity to critical neurovascular structures. OBJECTIVE: To describe the anatomical basis, surgical technique, and outcomes of a group of patients who underwent the endoscopic endonasal approach to the JF. METHODS: Five silicon-injected anatomical specimens were prepared for dissection. Additionally, a chart review was conducted through our patient database, searching for endonasal exposure of the JF. Demographic data, clinical presentation, pathological findings, extent of resection in the JF, and occurrence of complications were analyzed. RESULTS: The endonasal exposure of the JF requires 3 sequential steps: a transpterygoid, a “far-medial,” and an “extreme-medial” approach. Mobilization or transection of the cartilaginous portion of the eustachian tube (ET) is necessary. In the clinical series, cranial neuropathies were the presenting symptoms in 16 patients (89%). Eighteen tumors (10 chondrosarcomas, 7 chordomas, 1 adenocarcinoma) extended secondarily into the JF. Total tumor resection was achieved in 10 patients (56%), near total (≥90%) in 6 (33%), and subtotal (<90%) in 2 (11%). ET dysfunction (75% of cases), transient palatal numbness (17%), cerebrospinal fluid leakage (17%), and lower cranial nerve palsy (17%) were the most common postoperative complications. There were no carotid artery or jugular vein injuries. CONCLUSION: The endoscopic endonasal approach to the JF requires mobilization or transection of the cartilaginous portion of the ET. This maneuver provides a safe infrapetrosal surgical route to the JF. It may be considered a valid option, in well-selected cases, for resection of malignant and recurrent cranial base tumors.

Download Full-text