Endoscope assisted removal of jugular foramen schwannoma; report of 3 cases.

Removal of the intraforaminal portion of a jugular foramen schwannoma under direct vision requires resection of the adjacent bone. Extensive resection of the bone around the jugular foramen, however, involves a potential danger for cerebrospinal fluid (CSF) leakage and for damage to the adjacent cranial nerves as well as venous outflow. To avoid such bone resection, we applied the endoscope during the removal of a jugular foramen schwannoma through the lateral suboccipital approach. Three patients with schwannomas in the jugular foramen were treated using the lateral suboccipital approach with endoscopic assistance. After the intracranial portion was first removed under the microscope, the residual tumor in the jugular foramen was subsequently removed under the side-viewing endoscope. In all cases the tumor was removed successfully without major complications. The authors conclude that if the cases are selected properly, removal of the schwannoma extending into the jugular foramen is feasible through the conventional lateral suboccipital window under endoscopic assistance.