Optimal surgical approaches and treatment outcomes in patients with jugular foramen schwannomas: a single institution se
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ORIGINAL ARTICLE
Optimal surgical approaches and treatment outcomes in patients with jugular foramen schwannomas: a single institution series of 31 cases and a literature review Xiangyu Wang 1 & Wenyong Long 1 & Dingyang Liu 1 & Jian Yuan 1 & Qun Xiao 1 & Qing Liu 1 Received: 7 June 2019 / Revised: 8 August 2019 / Accepted: 15 August 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Complete resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve complications remains difficult even for skilled neurosurgeons. Between November 2011 and November 2017, 31 consecutive patients diagnosed with JFSs underwent a single-stage operation performed by the same neurosurgeon. We retrospectively analyzed clinical characteristics, surgical approaches, treatment outcomes, and follow-up data for these patients. JFSs were classified according to the Samii classification system. A retrosigmoid approach was used to resect type A tumors, while a suboccipital transjugular process (STJP) approach was used to resect type B tumors. Notably, the present study is the first to report the use of a paracondylar-lateral cervical (PCLC) approach for the treatment of type C and D tumors. Type A-D tumors were observed in seven, four, four, and 16 patients, respectively. Gross-total resection was achieved in 29 patients (93.5%). There were no cases of intracranial hematoma, reoperation, tracheotomy, or death. Adjunctive gamma knife treatment was used to manage residual tumors in two patients. Neurological deficits relieved in half of patients at the last follow-up. By reviewing the studies published on PubMed, the approaches gradually be more conservative, rather than widely expose the skull base. Nonetheless, endoscope and stereotactic radiosurgery plays an important role in the management of JFSs. Both tumor removal and neurological function retention can be obtained by choosing individual treatment. Keywords Skull base neoplasms . Schwannomas . Jugular foramen . Surgical approach . Paracondylar-lateral cervical approach
Introduction Jugular foramen schwannomas (JFSs) are rare, benign neoplasms of the skull base that arise from cranial nerves (CNs) IX, X, and XI around the jugular foramen. JFSs can extend into the intracranial and parapharyngeal spaces through the jugular foramen. Surgery involving this area usually places the lower CNs and vertebral and cerebellar arteries at high risk. Moreover, re-operation in this vital region is associated with severe CN deficits due to scarring from the previous surgery [5, 13]. Thus, the primary goal of JFSs management is to achieve total resection while preserving and restoring
* Qing Liu [email protected] 1
Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, People’s Republic of China
the function of CNs VII-XII. To date, only seven surgical series have included more than 20 cases of JFSs [2, 10, 14, 15, 17, 18, 22]. However, the most effective method for resecting dumbbell-like JFSs, especial
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