Efficacy of the Suboccipital Paracondylar-Lateral Cervical Approach: The Series of 64 Jugular Foramen Tumors Along With Follow-Up Data

ObjectiveComplete resection of jugular foramen tumors with minimal cranial nerve complications remains challenging even for skilled neurosurgeons. Here, we introduce a modified paracondylar approach, named the suboccipital paracondylar-lateral cervical (SPCLC) approach for this purpose. We also share the follow-up data of our series and discuss the advantages and limitations of this modified paracondylar approach.MethodsWe included 64 patients with jugular foramen tumors who underwent surgery by the same senior neurosurgeon between November 2011 and August 2020. All patients were treated with the SPCLC approach, which aimed for gross total tumor removal in a single-stage operation. The clinical characteristics, including preoperative and postoperative neurological status, the extent of surgical resection, and follow-up data were retrospectively acquired and evaluated.ResultsThere were 48 schwannomas, nine meningiomas, three paragangliomas, one hemangiopericytoma, one chordoma, one endolymphatic sac tumor, and one Langerhans’ cell histiocytosis. The median age of our patients was 43 years (range: 21–77 years). Dysphagia, hoarseness, and tongue deviation were observed in 36, 26, and 28 patients, respectively. Thirty-two patients had hearing function impairments, including hearing loss or tinnitus. Gross total resection was achieved in 59 patients (59/64, 92.2%). Gamma Knife treatment was used to manage residual tumors in five patients. Postoperatively, new-onset or aggravative dysphagia and hoarseness occurred in 26 and 18 cases, respectively. Nine patients developed new-onset facial palsy, and one patient developed new-onset hearing loss. There were no cases of intracranial hematoma, re-operation, tracheostomy, or death. At the latest follow-up, hearing loss and tinnitus had improved in 20 cases (20/32, 62.5%), dysphagia alleviated in 20 cases (20/36, 55.6%), and hoarseness improved in 14 cases (14/26, 53.8%). Over a mean follow-up period of 27.8 ± 19.5 months (range: 3–68 months), tumor recurrence was observed in one patient.ConclusionThe SPCLC approach, modified from the paracondylar approach, and was less invasive, safe, and efficient for certain jugular foramen tumors. Taking advantage of the anatomic understanding, clear operational vision, and appropriate surgical skills, it is possible to achieve gross total tumor removal and the preservation of neurological function.

Download Full-text

Surgical treatment of glossopharyngeal nerve schwannomas: Results of two-center study (14 patients included) and literature review

Ukrainian Neurosurgical Journal ◽

10.25305/unj.240739 ◽

2021 ◽

Vol 27 (4) ◽

pp. 23-29

Author(s):

Andrii H. Sirko ◽

Oleksandr M. Lisianyi ◽

Оksana Y. Skobska ◽

Rostislav R. Malyi ◽

Iryna O. Popovych ◽

...

Keyword(s):

Surgical Treatment ◽

Facial Nerve ◽

Hearing Impairment ◽

Cranial Nerves ◽

Type A ◽

Jugular Foramen ◽

Type B ◽

Tumor Removal ◽

Type D ◽

Total Tumor Removal

Objective: This study is aimed to analyze the outcomes of surgical treatment of glossopharyngeal schwannomas based on pre- and postoperative neurological status assessment. Materials and methods: This paper is a retrospective analysis of examination and surgical treatment of 14 patients who were operated on in two large clinics from 2018 to 2021 inclusive. When analyzing the collected data, gender, age, disease symptoms, tumor size and location, surgical approach, tumor to cranial nerves (CN) ratio, jugular foramen (JF) condition, and tumor removal volume were taken into account. All tumors were divided into groups depending on tumor location relative to the JF. Particular attention was paid to assessing cranial nerves functions. Facial nerve function was assessed as per House-Brackmann Scale (HBS), hearing function as per Gardner-Robertson Scale (GRS). Results: 3 (21.4%) patients had total tumor removal: 2 patients had type A tumors and one had type B tumor. Subtotal resection took place in 7 (50%) cases. In 4 cases, a tumor was partially removed: 3 patients had type D tumors and one had type B tumor. 3 (21.4%) patients had preoperative FN deficit (HBS Grade II) and mild dysfunction. 5 (35.7%) patients had postoperative facial nerve deficit: HBS ІІ, 2; ІІІ, 1; V, 2. Preoperative sensorineural type hearing impairment on the affected side was diagnosed in 13 (92.6%) patients. Before surgery, 6 patients had non-serviceable hearing, which remained at the same level after surgery. None of the patients with grade I or II hearing before surgery had any hearing impairment postoperatively. In 2 (14.3%) cases, hearing improved from grade V to grade III after surgery. 6 (42.9%) patients developed new neurological deficit in the caudal group CN. Postoperative deficit of the caudal group CN occurred in type D tumors in 3 patients, type A tumors 2 patients, and type B tumors one patient. Conclusions: Applying a retrosigmoid approach only makes it possible to achieve total tumor removal in case of type A tumors. To remove other tumor types, it is necessary to select approaches that enable access to the jugular foramen and infratemporal fossa. Intraoperative neurophysiological monitoring is an extremely important tool in glossopharyngeal schwannoma surgery. The most common postoperative complication is a developed or increased deficit of the caudal CN group, which can lead to persistent impairments in the patients’ quality of life. Preservation of the CN VII and VIII function in most cases is a feasible task and shall be ensured as a standard for this pathology.

Download Full-text

Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results

Journal of Neurosurgery ◽

10.3171/jns.1983.59.3.0395 ◽

1983 ◽

Vol 59 (3) ◽

pp. 395-401 ◽

Cited By ~ 189

Author(s):

Ivan Ciric ◽

Michael Mikhael ◽

Thomas Stafford ◽

Lawrence Lawson ◽

Rafael Garces

Keyword(s):

Recurrence Rate ◽

Residual Tumor ◽

Tumor Removal ◽

Content Type ◽

Long Term Follow Up ◽

Total Tumor Removal ◽

Postoperative Administration ◽

Pituitary Macroadenomas

✓ The authors have reported on 108 patients with pituitary macroadenomas (measuring 2 cm in at least one diameter) who underwent 117 transsphenoidal operations and five craniotomies, and were followed for periods ranging from 6 months to 14 years. Vision improved in 90% of the patients. Gross total tumor removal with no evidence of residual tumor tissue demonstrable on the postoperative computerized tomography scan was accomplished in 41% of cases. However, gross total tumor removal is not synonymous with complete tumor removal. Endocrine cure was possible in 25% of prolactin-secreting and 20% of growth hormone-secreting adenomas. The incidence of recurrence was 12%, with the majority occurring from 4 to 8 years postoperatively. Both the tumors with suprasellar extension of more than 2 cm and the hard fibrotic tumors had a higher recurrence rate. Postoperative administration of radiation therapy has been associated with a significantly lower recurrence rate than when this therapy was withheld. Transsphenoidal surgery of pituitary macroadenomas confined to the extra-arachnoid space is associated with a relatively small number of complications. The operative technique used in this series is described.

Download Full-text

TUBERCULUM SELLAE MENINGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000245600.92322.06 ◽

2006 ◽

Vol 59 (5) ◽

pp. 1019-1029 ◽

Cited By ~ 116

Author(s):

Makoto Nakamura ◽

Florian Roser ◽

Melena Struck ◽

Peter Vorkapic ◽

Madjid Samii

Keyword(s):

Tumor Resection ◽

Surgical Approaches ◽

Tumor Removal ◽

Neurosurgical Department ◽

Improvement Rate ◽

Visual Improvement ◽

Tuberculum Sellae ◽

Total Tumor Removal ◽

Frontolateral Approach

Abstract OBJECTIVE Tuberculum sellae meningiomas present a special challenge because of their proximity to arteries of the anterior circulation, anterior visual pathways, and the hypothalamus. The authors report on the clinical outcome after surgical treatment of tuberculum sellae meningiomas in our neurosurgical department. METHODS A retrospective study was conducted analyzing the charts of the patients, including surgical records, discharge letters, histological records, follow-up records, and imaging studies. Patients with associated neurofibromatosis Type 2 were excluded from the study. RESULTS One thousand eight hundred meningiomas were operated on between 1978 and 2002. Seventy-two of these patients had tuberculum sellae meningiomas; four had undergone previous surgical procedures in outside hospitals. Fifty-five patients were women; 17 were men. Their mean age was 54.3 years (range, 30–86 yr). All patients had visual disturbances at presentation. Tumors were operated through the bifrontal approach (n = 21, from 1978 through 1995), the pterional/frontotemporal approach (n = 21, from 1982 through 2002), and the frontolateral approach (n = 30, from 1984 through 2002). Total tumor removal was achieved in most patients (Simpson 1 + 2, 91.7%). The perioperative mortality rate was 2.8% (two out of 72 patients). Immediate postoperative improvement of visual disturbance was observed in 65% of patients. Visual improvement was dependent on the duration of preoperative visual symptoms, but not on preoperative visual acuity or tumor size. The visual improvement rate was significantly better in patients who underwent frontolateral tumor resection (77.8%) compared with those who underwent bifrontal craniotomy (46.2%). The overall recurrence rate was 2.8% (two out of 72 patients). The mean follow-up time for all patients was 4 to 238 months (mean, 45.3 mo [3.8 yr]). CONCLUSION From 1978 through 2002, tuberculum sellae meningiomas were removed microsurgically using three different surgical approaches. Considering the operative morbidity and mortality, the frontolateral and pterional approach provided remarkable improvement compared with the bifrontal approach. These approaches allowed quick access to the tumor and were minimally invasive with less brain exposure, but still engendered high rates of total tumor removal. By comparison, the frontolateral approach provided the best results concerning visual outcome while representing the least invasive surgical approach.

Download Full-text

Olfactory Groove Meningiomas: Clinical Outcome and Recurrence Rates after Tumor Removal Through the Frontolateral and Bifrontal Approach

Neurosurgery ◽

10.1227/01.neu.0000255453.20602.80 ◽

2007 ◽

Vol 60 (5) ◽

pp. 844-852 ◽

Cited By ~ 92

Author(s):

Makoto Nakamura ◽

Melena Struck ◽

Florian Roser ◽

Peter Vorkapic ◽

Madjid Samii

Keyword(s):

Clinical Outcome ◽

Recurrence Rate ◽

Tumor Resection ◽

Surgical Removal ◽

Tumor Removal ◽

Recurrence Rates ◽

Olfactory Groove ◽

Total Tumor Removal ◽

Frontolateral Approach

Abstract OBJECTIVE Olfactory groove meningiomas account for 8 to 13% of all intracranial meningiomas. Surgical removal is often performed through the bifrontal, unilateral subfrontal (frontolateral), or pterional approach. We report on the clinical outcome and recurrence rate after surgical treatment of olfactory groove meningiomas in our neurosurgical department. METHODS A retrospective study was conducted by analyzing the charts of the patients, including surgical records, discharge letters, histological records, follow-up records, and imaging studies. RESULTS A total of 1800 meningiomas were operated on between 1978 and 2002 in our department. There were 82 patients with olfactory groove meningiomas, including 63 women and 19 men with a mean age of 57.8 years (age range, 33–91 yr). Most patients presented with mental disturbance. Tumors were operated through the bifrontal (n = 46), frontolateral (n = 34), and pterional (n = 2) approaches. Total tumor removal (Simpson Grade 1 or 2) was achieved in most cases (91.2% frontolateral, 93.5% bifrontal). Perioperative mortality was 4.9% (four out of 82 patients, all operated through the bifrontal approach). The overall recurrence rate was 4.9%, with four patients requiring surgery. The mean follow-up period was 63.4 months (range, 4–270 mo). CONCLUSION Olfactory groove meningiomas were removed mainly through two different surgical approaches. Even in large tumors, high rates of total tumor resection could also be achieved with low recurrence rates using the simple and minimally invasive frontolateral approach. In recent years, we have preferred to use the frontolateral approach, which provides quick access to the tumor with less brain exposure while still enabling total tumor removal with a low morbidity rate and no mortality.

Download Full-text

Postoperative Cochlear Obliteration after Retrosigmoid Approach in Patients with Vestibular Schwannoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1608649 ◽

2017 ◽

Vol 79 (04) ◽

pp. 343-348 ◽

Cited By ~ 1

Author(s):

Alireza Hedjrat ◽

Konrad Schwager ◽

Erich Hofmann ◽

Robert Behr

Keyword(s):

Auditory Brainstem ◽

Retrosigmoid Approach ◽

Nerve Function ◽

Tumor Removal ◽

Promising Treatment ◽

Cochlear Ossification ◽

Left And Right ◽

Single Sided Deafness ◽

Total Tumor Removal

Objective Vestibular schwannomas (VSNs) account for the vast majority of lesions located in the cerebellopontine angle (CPA). The goals of VSN surgery are possible total tumor removal, intact facial nerve function, and preservation of cochlear nerve function. In cases of pre- or postoperative deafness, restoration of hearing with auditory brainstem implant (ABI) or cochlear implant (CI) is a promising treatment option with normally better results in CI than in ABI. The aim of this retrospective study is to evaluate cochlear ossification or obliteration secondary to a retrosigmoid approach, which is important for later CI, especially in single-sided deafness. Materials and Methods We retrospectively reviewed data from our suboccipital retrosigmoid operation database for the period from January 2008 to February 2015. A total of 65 patients with VSN could be analyzed retrospectively. The patient's data (age, gender, side of operation, tumor entities, and the duration of follow-up) were evaluated. The most recent T2-weigted MRI exams were taken into account for the evaluation of cochlea. To compare left and right sides, the coronal reformatted images were reconstructed in a symmetrical way. Results Twenty-two out of 65 (33%) patients had cochlear obliteration in our survey. The cochlear obliteration was more common in females (44 vs. 20% in males). The median follow-up was 28 months. The size and the intrameatal extension of tumors could not be considered as factors influencing the cochlear obliteration rate.According to our survey, 33% of suboccipital approaches manifested cochlear obliteration to some extent. It was more common in females. The intrameatal extension of tumors played statistically no role in the occurrence of postoperative cochlear obliteration. Whether the prohibition of cochlear ossification can be best achieved by retrosigmoid approaches, compared to other approaches to the CPA, or not could be a subject of future studies.

Download Full-text

Lower Cranial Nerve Schwannomas Involving the Jugular Foramen

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600503 ◽

1997 ◽

Vol 106 (5) ◽

pp. 370-379 ◽

Cited By ~ 34

Author(s):

Antonio Mazzoni ◽

Essam Saleh ◽

Mario Sanna ◽

Vittorio Achilli

Keyword(s):

Cranial Nerve ◽

Infratemporal Fossa ◽

Major Complication ◽

Cerebrospinal Fluid Leak ◽

Jugular Foramen ◽

Tumor Removal ◽

Lower Cranial Nerve ◽

Nerve Paralysis ◽

Total Tumor Removal ◽

Fluid Leak

Schwannomas involving the jugular foramen are rare lesions, and no consensus exists on their management. This paper reports on 20 such cases treated in our centers. Nineteen cases were operated on for removal of the tumors, and the remaining case is being managed by watchful expectancy. Fifteen cases were operated on by the petro-occipital trans-sigmoid approach with or without labyrinthectomy, 2 by the infratemporal fossa approach, 1 by the modified transcochlear approach, and 1 by the jugulo-petrosectomy approach. The petro-occipital trans-sigmoid approach allowed single-stage, total tumor removal with preservation of the facial nerve and of middle and inner ear functions. Lower cranial nerve paralysis was the major complication and seemed to be inherent to the disease rather than to the approach used. No cerebrospinal fluid leak or meningitis occurred in the present series. So far, no recurrence has been detected.

Download Full-text

Surgical treatment of glomus jugulare tumors without rerouting of the facial nerve: an infralabyrinthine approach

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.2.8 ◽

2004 ◽

Vol 17 (2) ◽

pp. 51-55 ◽

Cited By ~ 25

Author(s):

Luis A. B. Borba ◽

Samir Ale-Bark ◽

Charles London

Keyword(s):

Facial Nerve ◽

Surgical Approach ◽

Facial Palsy ◽

Jugular Foramen ◽

Nerve Function ◽

Tumor Removal ◽

Glomus Jugulare ◽

Anterior Transposition ◽

Radical Removal

Object Glomus jugulare tumors are benign lesions located in the jugular foramen that may or may not extend into the middle ear, petrous apex, and upper neck; these growths sometimes invade intradurally. The surgical management of these tumors is a challenge to neurosurgeons and skull base surgeons. Because of their abundant vascularity, deep location, complex anatomy, and difficult surgical approach, their treatment, has been a controversial issue for many years. Despite advancements in nonsurgical techniques, the only treatment with proven efficacy is radical surgical removal. The authors present a series of patients treated with radical removal, in which the feasibility of removing glomus jugulare tumors with low morbidity and a surgical approach limited to tumor removal are discussed. The extent of surgical exposure is tailored with emphasis placed on the routine anterior transposition of the facial nerve. Methods Between May 1997 and March 2004, 24 patients with glomus jugulare tumors were treated; 17 patients were women and seven were men. Their mean age at the time of diagnosis was 50 years (range 18–71 years). The most common symptom was hearing loss in 77%, followed by dysphagia and dysphonia in 55% of patients. In seven patients the clinical presentation was a facial palsy. Radical tumor removal was achieved in 23 patients. An anterior facial nerve transposition was not needed in any case. No surgery-related death was recorded in this series, although one patient died of a pulmonary embolism 70 days after the procedure. A one-stage procedure was performed in 23 patients and a two-stage procedure was used in the other patient. Cerebrospinal fluid leakage occurred in two patients. The lower cranial nerve function was worse in eight patients; however, only one had a new deficit. The facial nerve was preserved in all patients except one, in whom a large intradural tumor caused a temporary facial palsy. In the patients with pre-operative facial palsy, the tumor only compressed the nerve in three and it invaded the nerve in four. The nerve was decompressed in the cases with no invasion and a graft was placed in the others. The greater auricular nerve was used as a graft in three and the sural nerve was used in one. On follow-up review, the facial nerve function was House–Brackmann Grade 3 in three patients and Grade 2 in three. After 6 months of follow up with no improvement, one patient was referred for a facial muscle transfer. Conclusions The surgical technique must be tailored to each case. The authors believe that the standard surgical approach to jugular foramen tumors with anterior transposition of the facial nerve should be avoided, and that the extent of surgical exposure must be tailored to each case based on the extent of the tumor and the clinical symptoms. Lower morbidity rates and radical removal can be achieved with a good surgical plan.

Download Full-text

Reversible Hearing Loss from Cerebellopontine Angle Tumors

Neurosurgery ◽

10.1227/00006123-199102000-00024 ◽

1991 ◽

Vol 28 (2) ◽

pp. 310-313 ◽

Cited By ~ 20

Author(s):

Eduardo A. S. Vellutini ◽

Oswaldo L. M. Cruz ◽

Otavio P. Velasco ◽

Aroldo Miniti ◽

Gilberto M. Almeida

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Surgical Approach ◽

Cerebellopontine Angle ◽

Jugular Foramen ◽

Sensorineural Hearing ◽

Surgical Removal ◽

Arachnoid Membrane ◽

Tumor Removal ◽

Cerebellopontine Angle Tumors

Abstract We report two patients who presented with a dramatic recovery from severe sensorineural hearing loss after total surgical removal of cerebellopontine angle tumors (meningioma and jugular foramen neurinoma). The factors that differentiate these “non-acoustic tumors” in relation to the prognosis for hearing are discussed. A surgical approach that maintains the labyrinthine structure and preserves the arachnoid membrane of the superior cerebellopontine angle cistern during tumor removal is stressed.

Download Full-text

Surgical Management of Jugular Foramen Schwannomas

Cancers ◽

10.3390/cancers13164218 ◽

2021 ◽

Vol 13 (16) ◽

pp. 4218

Author(s):

Amir Kaywan Aftahy ◽

Maximilian Groll ◽

Melanie Barz ◽

Denise Bernhardt ◽

Stephanie E. Combs ◽

...

Keyword(s):

Hearing Loss ◽

Nerve Palsy ◽

Hypoglossal Nerve ◽

Surgical Intervention ◽

Facial Nerve Palsy ◽

Jugular Foramen ◽

Cerebellar Dysfunction ◽

Total Resection ◽

Gag Reflex

Background: Resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve (CN) injury remains difficult. Reoperations in this vital region are associated with severe CN deficits. Methods: We performed a retrospective analysis at a tertiary neurosurgical center of patients who underwent surgery for JFSs between June 2007 and May 2020. We included nine patients (median age 60 years, 77.8% female, 22.2% male). Preoperative symptoms included hearing loss (66.6%), headache (44.4%), hoarseness (33.3%), dysphagia (44.4%), hypoglossal nerve palsy (22.2%), facial nerve palsy (33.3%), extinguished gag reflex (22.2%), and cerebellar dysfunction (44.4%). We observed Type A, B, C, and D tumors in 3, 1, 1, and 4 patients, respectively. A total of 77.8% (7/9) underwent a retrosigmoid approach, and 33.3% (3/9) underwent an extreme lateral infrajugular transcondylar (ELITE) approach. Gross total resection (GTR) was achieved in all cases. The rate of shunt-dependent hydrocephalus was 22.2% (2/9). No further complications requiring surgical intervention occurred during follow-up. The median follow-up time was 16.5 months (range 3–84 months). Conclusions: Considering the satisfying outcome, the GTR of JFSs is feasible in performing well-known skull base approaches. Additional invasive and complicated approaches were not needed. Radiosurgery may be an effective alternative for selected patients.

Download Full-text

Clinical and Diagnostic Presentation of Gastrointestinal Stromal Tumour (GIST): A 5-Year Follow-Up

Revista Eletrônica Acervo Saúde ◽

10.25248/reas.e996.2019 ◽

2019 ◽

Vol 11 (13) ◽

pp. e996

Author(s):

Davi Sérgio dos Santos Pacífico ◽

Diego Aristeu Ramos Cruz ◽

Luan Kelves Miranda de Sousa ◽

Antonione Santos Bezerra Pinto

Keyword(s):

Gastrointestinal Stromal Tumour ◽

Good Prognosis ◽

Gastrointestinal Tumor ◽

Tumor Removal ◽

Mesenchymal Tumors ◽

Immunohistochemistry Analysis ◽

Diagnostic Characteristics ◽

Total Tumor Removal

Objective: To describe a clinical case of Stromal Gastrointestinal Tumor, highlighting the diagnostic characteristics and a 5-year follow-up of the patient after surgery. Case report: A 51-year-old patient presented with a tumor in the stomach region, diagnosed by the clinic, associated with imaging and immunohistochemistry, in which a partial abdominal gastrectomy was performed for total tumor removal and after a surgical procedure pharmacological treatment with GLIVEC chemotherapy for 3 years, with cure. Final considerations: Gastrointestinal stromal tumors are very common mesenchymal tumors in the region of the gastrointestinal tract. Its severity is known and investigated through the clinic for diagnosis, associated with imaging and immunohistochemistry analysis, in order to observe the tumor markers, mainly the c-KIT. The treatment involves several modalities seeking to improve the patients' quality of life and, generally, they present a good prognosis.

Download Full-text