Endoscope-Assisted, Transmastoid, High Cervical Approach for Resection of a Jugular Foramen Schwannoma: 2-Dimensional Operative Video.

Jugular foramen schwannomas (JFSs) are relatively rare, benign lesions that account for 10% to 30% of all tumors in the region of the jugular foramen. Given their slow-growing nature, JFSs can become quite large before causing symptoms of lower cranial nerve (LCN) dysfunction, making microsurgical resection a challenge. Successful resection of any JFS is dependent on the identification and preservation of the adjacent, uninvolved LCNs to alleviate nerve compression and preserve function. We report a transmastoid, high cervical approach to a dumbbell-shaped, extracranial JFS that was causing symptomatic LCN compression. The patient presented with dysphagia and was found to have left vocal cord paralysis on video laryngoscopy and intermittent aspiration on a swallowing evaluation. The transmastoid, high cervical exposure allowed for early identification of the tumor as well as the adjacent LCNs. Neurophysiological monitoring included somatosensory evoked potentials; brainstem auditory evoked responses; and cranial nerve VII, X, XI, and XII electromyographic monitoring. Endoscopic assistance allowed for improved LCN visualization from the high cervical exposure and gross-total resection of the tumor. The patient's dysphagia improved both subjectively and objectively following the resection. The patient gave written informed consent for surgery and publication of the case report. Institutional review board approval was not required for this case report. Used with permission from Barrow Neurological Institute.