title: Microsurgical management of jugular foramen schwannomas.
abstract: BACKGROUND
  Jugular foramen schwannomas are uncommon and surgically challenging lesions.
  
  
  OBJECTIVE
  To determine the importance of surgical technique on morbidity and recurrence of jugular foramen schwannomas.
  
  
  METHODS
  A retrospective review and case-control analysis of a single-senior-surgeon series of 81 patients with surgically treated jugular foramen schwannomas was performed, focusing on operative technique. Patients undergoing an aggressive, total tumor resection (series 1) were compared with those undergoing more conservative resection focusing on preserving the pars nervosa (series 2).
  
  
  RESULTS
  There was a statistically significant (P = .04) decrease in permanent deficits of the cranial nerve 9/10 complex with a conservative technique. Recurrence was seen in 3 patients (5.7%) in series 1 and in 3 patients (10.7%) in series 2 (P = .36). Recurrence was treated with reoperation in 1 patient, radiation in 1 patient, and observation in the others.
  
  
  CONCLUSIONS
  Although radical gross total resection is desirable, it is not optimal for cranial nerve preservation in patients with jugular foramen schwannomas. A more conservative approach resulted in a statistically significant decrease in lower cranial nerve deficits. There was a nonstatistically significant trend toward increasing recurrence, which may be treated with multiple modality therapy in the modern era.
authors.affiliation: Department of Neurosurgery, West Virginia University, Morgantown, West Virginia 26506, USA. csedney@hsc.wvu.edu
authors.forename: Cara L
authors.initials: CL
authors.lastname: Sedney
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nonaka
authors.forename: Ketan R
authors.initials: KR
authors.lastname: Bulsara
authors.forename: Takanori
authors.initials: T
authors.lastname: Fukushima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D002648:Child; D015331:Cohort Studies; D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009442:Neurilemmoma / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult