Skip to main content
Journal cover image

Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach.

Publication ,  Journal Article
Nonaka, Y; Grossi, PM; Bulsara, KR; Taniguchi, RM; Friedman, AH; Fukushima, T
Published in: Neurosurgery
December 2011

BACKGROUND: Schwannomas originating from the hypoglossal nerve are extremely rare. Microsurgical resection with the goal for cure has traditionally been associated with a high risk of postoperative deficits. OBJECTIVE: To summarize our clinical experience using tailored cranial base approaches for these formidable lesions. METHODS: The clinical records of 13 patients were retrospectively reviewed. In addition, all reported patients in the literature were reviewed. The extreme lateral infrajugular transcondylar-transtubercular exposure approach was used in all of our patients. Based on our experience and literature analysis, we propose the following modified grading scale to facilitate surgical planning: type A, intradural tumors; type B, dumbbell-shaped tumors; type C, extracranial tumors; and type D, peripheral tumors. RESULTS: All 13 patients underwent total, near-total, or subtotal tumor resection. Eight patients were men, 5 were women (mean age, 41.7 years). Sural nerve graft reconstruction for the hypoglossal nerve was performed in 4 patients. Three of the 4 patients in whom nerve reconstruction was performed regained satisfactory movement of their tongue. In the review of the literature, the mean patient age was 45.8 years. Patients presented with tongue atrophy (91.6%), headache (60.9%), and dysphagia (31.8%). The tumors were categorized as type A in 31.7% of these patients, type B in 38.6%, type C in 6.2%, and type D in 23.4%. CONCLUSION: The extreme lateral infrajugular transcondylar-transtubercular exposure approach, which is a modification of the extreme lateral suboccipital approach, provides sufficient exposure for most intracranial dumbbell-shaped hypoglossal schwannomas. Hypoglossal nerve reconstruction using a sural nerve graft improves tongue atrophy and movement for patients with resected nerves.

Duke Scholars

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

December 2011

Volume

69

Issue

2 Suppl Operative

Start / End Page

ons121 / ons140

Location

United States

Related Subject Headings

  • Young Adult
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Neurilemmoma
  • Middle Aged
  • Microsurgery
  • Male
  • Hypoglossal Nerve Diseases
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Nonaka, Y., Grossi, P. M., Bulsara, K. R., Taniguchi, R. M., Friedman, A. H., & Fukushima, T. (2011). Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach. Neurosurgery, 69(2 Suppl Operative), ons121–ons140. https://doi.org/10.1227/NEU.0b013e31822a547b
Nonaka, Yoichi, Peter M. Grossi, Ketan R. Bulsara, Raymond M. Taniguchi, Allan H. Friedman, and Takanori Fukushima. “Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach.Neurosurgery 69, no. 2 Suppl Operative (December 2011): ons121–40. https://doi.org/10.1227/NEU.0b013e31822a547b.
Nonaka Y, Grossi PM, Bulsara KR, Taniguchi RM, Friedman AH, Fukushima T. Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach. Neurosurgery. 2011 Dec;69(2 Suppl Operative):ons121–40.
Nonaka, Yoichi, et al. “Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach.Neurosurgery, vol. 69, no. 2 Suppl Operative, Dec. 2011, pp. ons121–40. Pubmed, doi:10.1227/NEU.0b013e31822a547b.
Nonaka Y, Grossi PM, Bulsara KR, Taniguchi RM, Friedman AH, Fukushima T. Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach. Neurosurgery. 2011 Dec;69(2 Suppl Operative):ons121–ons140.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

December 2011

Volume

69

Issue

2 Suppl Operative

Start / End Page

ons121 / ons140

Location

United States

Related Subject Headings

  • Young Adult
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Neurilemmoma
  • Middle Aged
  • Microsurgery
  • Male
  • Hypoglossal Nerve Diseases
  • Humans
  • Female