The Microsurgical Treatment Of The Jugular Foramen Schwannomas

Object:to study the clinical manifestations, imaging data, microsurgery, long-term neurological function, quality of life, tumor recurrence and progression of the jugular foramen schwannoma. Explore the location and origin of the tumor, the classification and surgical approach about the tumors.Material and Method:A retrospective analysis of clinical data and its follow-up of25cases jugular foramen schwannoma, which operated by Professor Yuan Xianrui from April1998to May2011in Xiangya Hospital Central South University. The main symptoms in patients with hearing loss(16cases), tinnitus(14cases), ataxia(13cases), drink cough(10cases), dysphagia(7cases), hoarseness(9cases), hemiglossoplegia(8cases), facial numbness(7cases), headache(17cases),dizziness(10cases). Disease duration course were from1to144months(average39.5months), tumor intracranial diameter was41.0±15.5mm(0-60mm), extracranial diameter was7.8±12.1mm(0--30mm). According to the classification of Kaye and Pellet, tumor was type A in17cases of25patients, type D in6patients and type C in2patients. A suboccipital transcervico-jugular process approach was used for12patients. A retrosigmoid approach was used for10patients. A far lateral approach was used for1patient. A combined approach was used for other2patients. Detailed record the patients' postoperative data, regular follow-up, and neurological functions, the quality of life, brain MRI or CT were all recorded in the follow-up table.Results:Tumors total resection was achieved in23of25cases (92%) and no operative deaths. There were20cases have follow-up, the mean follow-up period was5.9years (1-14years). The mean quality of life score (KPS) was88.5(70-100),18(90%) patients has full daily activity (KPS Score80-100) and2(10%) patients were able to live at home and care for most personal needs (KPS Score50-70). Preoperative lower cranial nerve dysfunction was found in15patients, including3patients of postoperative improvement and12patients of persistent symptoms;6patients had new lower cranial nerve dysfunction (24%);4patients had normal lower cranial function both preoperative and postoperative.12patients needed nasogastric and4patients needed tracheotomy. The lower cranial nerve function was improved in all follow-up patients.2patients had facial paralysis preoperative and4patients (16%) had new facial paralysis postoperative, they were all returning to normal in follow-up. Hearing loss symptoms improved in2patients, no aggravated cases.4patients who completed hearing loss preoperative were not restored in postoperative and follow-up. The other complication contain incision leakage of cerebrospinal fluid, epidural hematoma, subcutaneous fluid and hydrocephalus in1patient each (4%each), lung infection in2patients (8%). Two cases of recurrence in the20total resection cases, the recurrence rate10%.Conclusion:1. The patient of jugular foramen schwannoma undergoing microsurgery can obtain a good long-term outcome, the operation is the preferred treatment.2. The preoperative cranial nerve dysfunction also aggravate after operation, and also the likely emergence of new cranial nerve dysfunction, but this dysfunction is usually transient, which can be improved in a certain period of time.3. Suboccipital transcervico-jugular process approach can provide adequate anatomical exposure for most of jugular foramen schwannoma.4. The majority of jugular foramen schwannoma origin from the glossopharyngeal or vagus nerve, which relate to their ganglia in the jugular foramen. The derection of growth of the tumor depend on the tumor origination, either proximal or distal origin from the jugular foramen, determines the direction and pattern of growth intracranially or extracranially.