Strategies in the Management of Lower Cranial Nerve Schwannomas: Insights From the Gruppo Otologico.

Abstract

Background and objectives: Jugular foramen schwannoma is a rare benign tumor arising from the lower cranial nerves. After reviewing their experience with microsurgical management of jugular foramen schwannomas through lateral skull base and transcervical approaches, the authors recommend a management algorithm to direct simplified surgical management.

Methods: Cases of jugular foramen schwannomas treated by the senior author between 1983 and 2024 were analyzed retrospectively. Sociodemographic data, clinical presentation, radiological and intraoperative tumor characteristics, histopathological results, surgical approaches, and postoperative course until the last visit were thoroughly documented and analyzed.

Results: A total of 53 cases of jugular foramen tumors were treated over a 40-year period. Age at presentation ranged from 13 to 76 years, with a mean age of 42.84 years. Women comprised 53% (n = 28) of the total patients operated on, whereas the rest, 47% (n = 25), were men. The most common presenting symptoms were hearing loss and dysphagia. Tumors were classified according to the Kaye and Pellet classification system into classes A (11.32%), B (39.62%), C (15.09%), and D (33.96%). The most commonly used surgical approach was the petro-occipital trans-sigmoid approach, either alone or combined with other approaches, and gross total removal was achieved in 98% of patients. New postoperative paralysis in previously normal lower cranial nerve function was evident in 44% (n = 8) of patients who had normal lower cranial nerve function before surgery. The duration of follow-up ranged from 12 to 144 months, with a mean follow-up period of 63.46 months. Three patients (5.6%) had tumor recurrence.

Conclusion: Based on their experience, the authors have proposed a treatment algorithm that guides the best surgical strategy. Even if gross total tumor removal of jugular foramen area lesions can safely be achieved nowadays, an extensive understanding of microsurgical anatomy of the area and surgical training is mandatory.