Surgical management and outcome of schwannomas in the craniocervical region.
OBJECTIVE
Schwannomas occupying the craniocervical junction (CCJ) are rare and usually originate from the jugular foramen, hypoglossal nerves, and C-1 and C-2 nerves. Although they may have different origins, they may share the same symptoms, surgical approaches, and complications. An extension of these lesions along the posterior fossa cisterns, foramina, and spinal canal--usually involving various cranial nerves (CNs) and the vertebral and cerebellar arteries--poses a surgical challenge. The primary goals of both surgical and radiosurgical management of schwannomas in the CCJ are the preservation and restoration of function of the lower CNs, and of hearing and facial nerve function. The origins of schwannomas in the CCJ and their clinical presentation, surgical management, adjuvant stereotactic radiosurgery, and outcomes in 36 patients treated at Barrow Neurological Institute (BNI) are presented.


METHODS
Between 1989 and 2009, 36 patients (mean age 43.6 years, range 17-68 years) with craniocervical schwannomas underwent surgical resection at BNI. The records were reviewed retrospectively regarding clinical presentation, radiographic assessment, surgical approaches, adjuvant therapies, and follow-up outcomes.


RESULTS
Headache or neck pain was present in 72.2% of patients. Cranial nerve impairments, mainly involving the vagus nerve, were present in 14 patients (38.9%). Motor deficits were found in 27.8% of the patients. Sixteen tumors were intra- and extradural, 15 were intradural, and 5 were extradural. Gross-total resection was achieved in 25 patients (69.4%). Adjunctive radiosurgery was used in the management of residual tumor in 8 patients; tumor control was ultimately obtained in all cases.


CONCLUSIONS
Surgical removal, which is the treatment of choice, is curative when schwannomas in the CCJ are excised completely. The far-lateral approach and its variations are our preferred approaches for managing these lesions. Most common complications involve deficits of the lower CNs, and their early recognition and rehabilitation are needed. Stereotactic radiosurgery, an important tool for the management of these tumors as adjuvant therapy, can help decrease morbidity rates.
Cavalcanti
Daniel D
DD
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Martirosyan
Nikolay L
NL
Verma
Ketan
K
Safavi-Abbasi
Sam
S
Porter
Randall W
RW
Theodore
Nicholas
N
Sonntag
Volker K H
VK
Dickman
Curtis A
CA
Spetzler
Robert F
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D003131:Combined Modality Therapy; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000175:diagnosis / Q000601:surgery*; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D016634:Radiosurgery; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000601:surgery*; D055815:Young Adult