Management of jugular foramen Schwannomas

Abstract

To discuss surgical approach selection and treatment strategy for preservation of the facial and lower cranial nerves' function in jugular foramen schwannomas surgery. Retrospectively analyzed the clinical presentation, surgical approaches selection, facial and lower cranial nerves follow-up outcomes of 38 jugular foramen Schwannomas, who received operations in the Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital affiliated to Shanghai Jiaotong University, School of Medicine during 2002 and 2012. A total of 38 patients, including 18 men and 20 women, with ages ranged from 21 to 70 years (mean 45.3). Headache or neck pain in preoperative clinical presentation was present in 27 patients (71.1%) and cervical mass in 9 patients (23.7%). Cranial nerve impairments, mainly the vagus nerve, were present in 21 patients (55.3%). MRI finding: 19 tumors were intra- and extracranial, 10 were intracranial and 9 were extracranial. According to the tumor location and region, select the surgical approaches. 25 patients used infratemporal fossa type A approach, 5 patients used petrous occipital transsigmoid approach and 8 patients used transcervial approach to remove tumors. The percentage of total resection was 92.1% (35/38). Adjunctive radiosurgery was used in the management of residual tumor in two patients. All cases obtained ultimately tumor control. Patients were followed by MRI every 6 months for 1 year. Thereafter, they performed follow-up imaging every 1-2 years, and the cranial nerve function was analyzed and evaluated. They were followed up from 26-124 months (median follow-up was 62.3 months). During follow-up period, good facial function was obtained in 36 patients (94.7%). All patients had no swallowing disorder. Complete compensation of lower cranial nerve function was achieved in all patients. The preoperative estimation and location of tumor in nature is of great importance in the determination of proper surgical planning of jugular foramen Schwannomas. Facial nerve and lower cranial nerve function can be preserved in maximal degree by proper surgical approaches and careful operative manipulation. Initial surgical resection followed by radiosurgery may be an effective option for some special patients.