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Surgical treatment of dumbbell-shaped hypoglossal schwannoma via a pure endoscopic transoral approach

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Abstract

Background

Dumbbell-shaped hypoglossal schwannomas with intradural and extradural extension are extremely rare, and complete removal of these tumors is very difficult. This report describes such lesions in three patients that were completely removed via a purely endoscopic transoral approach.

Method

Three patients with intradural and extradural growth hypoglossal schwannomas (three women, aged 16, 42 and 43 years) were treated by direct surgery via a purely endoscopic transoral approach to the posterior fossa.

Results

In this series, radical resections of the dumbbell-shaped hypoglossal schwannomas were achieved in all three patients via a purely endoscopic transoral approach without creating additional cranial nerve deficits but temporary left vagus palsy in one case and a temporary left hypoglossal palsy in one case. The postoperative vagus and hypoglossal palsy had recovered in 3 months after surgery. No patient experienced complications such as postoperative cerebrospinal fluid leak, meningitis and cerebrovascular evidence. At the time of this review, the preoperative lingual motor function and muscular bulk had recovered but hemiatrophy of the tongue was still detectable. The preoperative vagus palsy had recovered by the 10th day after surgery. The hearing loss and facial palsy before surgery had completely recovered in 3 months postoperatively. No patient in our series has experienced a recurrence for the follow-up period (3–11 months).

Conclusions

Dumbbell-shaped hypoglossal schwannomas tend to cause lower cranial nerve deficits, facial paralysis and hearing loss. With appropriate preoperative evaluation and careful planning of the perioperative period, complete tumor resection can be achieved via the purely endoscopic transoral approach. The endoscopic transoral approach is an effectice choice for management of dumbbell-shaped hypoglossal schwannomas.

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Authors and Affiliations

  1. Skull Base Surgery Center, Department of Neurosurgery, Capital Medical University Xuanwu Hospital, No. 45 Changchunjie Street, Xicheng District, Beijing, Peoples’ Republic of China, 100053

    Qiuhang Zhang, Feng Kong, Hongchuan Guo, Ge Chen, Jiantao Liang, Mingchu Li & Feng Ling

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  1. Qiuhang Zhang
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  2. Feng Kong
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  3. Hongchuan Guo
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  4. Ge Chen
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  5. Jiantao Liang
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  6. Mingchu Li
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  7. Feng Ling
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Corresponding author

Correspondence to Qiuhang Zhang.

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Comment

Quihang and colleagues have described the successful removal of dumbbell-shaped hypoglossal schwanommas in 3 patients via a transoral approach with endoscopic guidance. The authors are to be commended for their successful management of these difficult tumors, with no long term complications. This reviewer thought that the approach is rational, and in fact provides a very reasonable trajectory for complete removal of these specific tumors shown. The major concerns with the use of the approach is the transoral corridor to the intradural component, with its inherent risk of associated infection, and avoidance of injury to the carotid and vertebral arteries and brainstem. Drilling of the anterior aspect of the occipital condyle was necessary in 2 of the 3 cases, and the surgeon must be careful to minimize the drilling of this structure to avoid and instability of the occipitocervical joint. I note that the patients were discharged 10, 12 and 12 days after surgery, which is much longer than would be expected following a traditional far lateral approach for removal of these tumors. Perhaps with more experience this might be reduced.

W.T.Couldwell

Utah, USA

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Zhang, Q., Kong, F., Guo, H. et al. Surgical treatment of dumbbell-shaped hypoglossal schwannoma via a pure endoscopic transoral approach. Acta Neurochir 154, 267–275 (2012). https://doi.org/10.1007/s00701-011-1193-0

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  • DOI: https://doi.org/10.1007/s00701-011-1193-0

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