Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
J Neurosurg. 2011 May;114(5):1257-67. doi: 10.3171/2010.5.JNS0966. Epub 2010 Jul 9.
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.
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.
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.
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.
占据颅颈交界区（CCJ）的神经鞘瘤很少见，通常起源于颈静脉孔、舌下神经和 C1 和 C2 神经。尽管它们可能有不同的起源，但它们可能有相同的症状、手术入路和并发症。这些病变沿着后颅窝池、孔和椎管延伸，通常涉及各种颅神经（CNs）和椎动脉及小脑动脉，这给手术带来了挑战。CCJ 神经鞘瘤的手术和放射外科治疗的主要目标是保留和恢复下颅神经、听力和面神经功能。本文介绍了巴罗神经学研究所（BNI）治疗的 36 例 CCJ 神经鞘瘤患者的起源、临床表现、手术治疗、辅助立体定向放射外科治疗和结果。
1989 年至 2009 年，BNI 对 36 例（平均年龄 43.6 岁，范围 17-68 岁）颅颈神经鞘瘤患者行手术切除。回顾性分析其临床表现、影像学评估、手术入路、辅助治疗和随访结果。
72.2%的患者有头痛或颈部疼痛。14 例（38.9%）患者存在颅神经损伤，主要涉及迷走神经。27.8%的患者存在运动障碍。16 例肿瘤为硬膜内外，15 例为硬膜内，5 例为硬膜外。25 例患者行肿瘤全切除（69.4%）。8 例患者采用辅助放射外科治疗残留肿瘤，最终所有病例均获得肿瘤控制。
CCJ 神经鞘瘤完全切除是治疗的首选方法，可达到治愈效果。远外侧入路及其各种改良入路是我们治疗这些病变的首选方法。最常见的并发症涉及颅神经功能障碍，需要早期识别和康复。立体定向放射外科是治疗这些肿瘤的重要辅助手段，有助于降低发病率。
