Institutional members access full text with Ovid®

Microsurgical Management of Jugular Foramen Schwannomas

Sedney, Cara L. MD*; Nonaka, Yoichi MD, PhD; Bulsara, Ketan R. MD§; Fukushima, Takanori MD, DMsc

doi: 10.1227/NEU.0b013e3182770e74
Research-Human-Clinical Studies

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.

ABBREVIATION: JFS, jugular foramen schwannoma

*Department of Neurosurgery, West Virginia University, Morgantown, West Virginia

Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

§Department of Neurosurgery, Yale University, New Haven, Connecticut

Correspondence: Cara L. Sedney, MD, Department of Neurosurgery, PO Box 9183, Robert C. Byrd Health Sciences Center, Morgantown, WV 26506. E-mail: csedney@hsc.wvu.edu

Received February 20, 2012

Accepted September 25, 2012

Copyright © by the Congress of Neurological Surgeons