Introduction: Jugular foramen schwannomas (JFS) represent rare tumors of the skull base. Less than five hundred cases of JFS have been reported in the literature. No consensus exists on their management. They are treated either by watchful expectancy, microsurgical removal or stereoradiosurgery. Aim of our study is to present longterm results of microsurgically treated JFS.

Methods: All data of consecutive patients microsurgically treated for JFS were analyzed retrospectively. All tumors were radically removed in one or two session. Operative approach was chosen according to the type of the tumor; A (intracranial), B (intraosseous), C (extracranial) or D (saddleback-dumbbell-shaped) according to Kaye et al. (1984) and Pellet et al. (1988). Intraoperative monitoring of evoked potentials helped us to reduce the risk of injury to the neural structures. Each patient was carefully monitored before, during and after the surgery. Five of those 25 patients were unsuccessfully treated before the microsurgery by several different methods including the stereoradiosurgery by Leksell Gamma Knife (LGN).

Results: Our post-operative follow-up of 25 patients observed for up to 29 years did not show any mortality, just temporal or partial tolerable lesions of cranial nerves IX, X, XI, and only two tumor recurrences 11 and 14 years after the first surgery. These were successfully reoperated.

Conclusions: The microsurgical radical removal of jugular foramen schwannomas seems to be superior to all other methods of treatment including the LGN surgery.

Patient Care: Improved indication of microsurgery in jugular foramen schwannomas.

Learning Objectives: At the end of the session followers should be able to choose the optimal surgical approach for different types of jugular foramen schwannoma.

References: Samii M, Gerganov V. Surgery of Cerebellopontine Lesions: Springer; 2013. pp 885.