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Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system.

Publication ,  Journal Article
Bulsara, KR; Sameshima, T; Friedman, AH; Fukushima, T
Published in: J Neurosurg
November 2008

OBJECT: Due to the proximity and involvement of critical neurovascular structures, the resection of jugular foramen schwannomas can pose a formidable challenge. The authors review their experience in the microsurgical management of jugular foramen schwannomas and propose a modified grading scale to guide surgical management. METHODS: All jugular foramen schwannoma cases treated by the senior author (T.F.) between 1980 and 2004 were retrospectively reviewed. The average age at presentation, surgical approach, tumor characteristics, cranial nerve (CN) deficits, and tumor recurrence rates were assessed. The authors present the following modified grading scale: Type A, intradural tumors; Type B, dumbbell-shaped tumors; and Type C, triple dumbbell tumors with a high cervical extension. RESULTS: The authors treated jugular foramen tumors in 129 patients during the study period. Of these, 53 patients (41%) had jugular foramen schwannomas. The mean patient age was 52 years (range 14-74 years); there were 12 male and 41 female patients. The mean follow-up period was 8.4 years. Patients presented most commonly with deficits of the vagus nerve, followed by vestibular/cochlear nerve and glossopharyngeal nerve deficits. Gross-total resection of the tumor was achieved in 48 patients (90.5%). New postoperative paresis in a previously normal CN was not seen; however, worsening of preoperative CN deficits was frequently noted. The highest incidence occurred with the glossopharyngeal and vagus nerves (30%), with 26% of the deficits being permanent. There were no deaths related to surgery in this series. Three patients (5.7%) experienced tumor recurrence. CONCLUSIONS: The microsurgical resection of jugular foramen schwannomas carries a risk of worsening preoperative CN deficits; however, these are often transient. Based on their experience, the authors have formulated a grading scale that predicts the optimal surgical approach to these lesions. Considerable technical training and microneuroanatomical knowledge of the region is required. The modified grading scale presented facilitates preoperative planning.

Duke Scholars

Published In

J Neurosurg

DOI

ISSN

0022-3085

Publication Date

November 2008

Volume

109

Issue

5

Start / End Page

794 / 803

Location

United States

Related Subject Headings

  • Young Adult
  • Skull Base
  • Retrospective Studies
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Neurilemmoma
  • Middle Aged
  • Microsurgery
  • Male
  • Magnetic Resonance Imaging
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bulsara, K. R., Sameshima, T., Friedman, A. H., & Fukushima, T. (2008). Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system. J Neurosurg, 109(5), 794–803. https://doi.org/10.3171/JNS/2008/109/11/0794
Bulsara, Ketan R., Tetsuro Sameshima, Allan H. Friedman, and Takanori Fukushima. “Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system.J Neurosurg 109, no. 5 (November 2008): 794–803. https://doi.org/10.3171/JNS/2008/109/11/0794.
Bulsara KR, Sameshima T, Friedman AH, Fukushima T. Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system. J Neurosurg. 2008 Nov;109(5):794–803.
Bulsara, Ketan R., et al. “Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system.J Neurosurg, vol. 109, no. 5, Nov. 2008, pp. 794–803. Pubmed, doi:10.3171/JNS/2008/109/11/0794.
Bulsara KR, Sameshima T, Friedman AH, Fukushima T. Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system. J Neurosurg. 2008 Nov;109(5):794–803.

Published In

J Neurosurg

DOI

ISSN

0022-3085

Publication Date

November 2008

Volume

109

Issue

5

Start / End Page

794 / 803

Location

United States

Related Subject Headings

  • Young Adult
  • Skull Base
  • Retrospective Studies
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Neurilemmoma
  • Middle Aged
  • Microsurgery
  • Male
  • Magnetic Resonance Imaging