Jugular foramen schwannomas: A single institution patient series

Abstract

Jugular foramen schwannomas are rare. To our knowledge only a small number of series including a large number of patients have been reported. We aimed to analyse the clinical characteristics, surgical approaches, and outcome of patients undergoing treatment for jugular foramen schwannomas via a retrospective analysis of departmental records. Data for 28 patients treated for jugular foramen schwannomas in the Department of Neurosurgery at our tertiary level referral institution between January 2001 and December 2010 were analysed. Most patients were in the fourth decade of life, with the duration of symptoms ranging from 1 month to 13 years. A skull base approach was used in every surgically treated patient. Of the 19 patients for whom radiological follow-up were available, complete tumor excision was achieved in 17 patients. Follow-up ranged from 3 months to 59 months (mean, 32 months). One patient died and three had permanent morbidity in the form of facial nerve palsy. Jugular foramen schwannomas are best treated by total surgical resection. Partial resection is appropriate for tumors with adhesions to the brainstem and in medically unfit patients. Subsequent radiosurgery can be used for small residual tumors. Introduction Cranial nerve sheath tumors constitute 5–10% of all intracranial neoplasms.1 Jugular foramen (JF) schwannomas arising from cranial nerves nine, ten, and eleven are rare, constituting approximately 2.9% to 4% of all intracranial schwannomas.2 JF schwannomas represent 10–30% of all tumors observed around the jugular foramen.3, 4 JF patients present with signs and symptoms which often overlap with those of meningiomas, glomus jugulare tumors, and occasionally vestibular schwannomas, making JF schwannomas a challenge to distinguish preoperatively. Patients with JF schwannomas can present with loss of function of the affected nerve, but they can also be asymptomatic. In these latter patients, the lesion may be incidentally discovered on CT scans or MRI obtained for reasons other than the evaluation of the schwannoma. Morbidity resulting from schwannomas includes cranial nerve dysfunction and brainstem compression. Mortality can result from mass effect with brainstem compression. The most appropriate surgical approach for these tumors remains controversial. Recently the number of reports has increased, although most of these articles are case reports, with few large series in the medical literature. We report our experience with 28 patients with these tumors. It is one of the largest series of JF schwannomas in the English medical literature.