頚静脈孔神経鞘腫

Jugular Foramen Schwannoma

Point

・頚静脈孔神経鞘腫のアプローチは腫瘍の発育パターンによって決まる．

・外側後頭下開頭が基本となるため，その手技に精通しておく必要がある．

・定位放射線治療の成績も良好であるため，機能温存を最優先して摘出する．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年8月まで）。

　Jugular foramen schwannoma is a rare intracranial tumor, with few opportunities for surgeons to perform tumor excision. This study aimed to provide an outline of jugular foramen schwannoma and our surgical strategy for this tumor. The surgical approach depends on tumor growth patterns with or without extracranial extension. In our institute, a lateral suboccipital retrosigmoid approach is used for intracranial tumors, and mastoidectomy is added for extracranial tumors. For accuracy and safety, neuronavigation and intraoperative neurological monitoring are applied to assist surgery. Herein details of surgical procedures are described. Because functional preservation is prioritized in surgery, intracapsular removal is recommended to prevent adhering cranial nerves from being injured by direct manipulation. Stereotactic radiosurgery has also shown good tumor control. Therefore, the goal of treatment is to achieve good tumor control without deterioration of neurological status during a patient's lifetime using both microsurgery and stereotactic radiosurgery. When considering patient-specific factors such as age and tumor size, less invasive skull base surgery is still necessary to treat jugular foramen schwannoma, for which neurosurgeons require knowledge of the anatomy around the jugular foramen and skills specific to such surgery.