| SKULL BASE REGION | Jugular foramen |
| HISTOPATHOLOGY | Schwannoma originating from vagus nerve |
| PRIOR SURGICAL RESECTION | Yes |
| PERTINENT LABORATORY FINDINGS | None |
Case description
The 30-year-old patient was incidentally found to have a large jugular foramen mass consistent with schwannoma on imaging ( Figure 10.51.1 ). Examination revealed normal cranial nerve function. The patient was offered observation, upfront stereotactic radiosurgery (SRS), and subtotal resection with postoperative SRS. He elected the retrosigmoid approach for subtotal resection with preservation of the lower cranial nerves, which confirmed a diagnosis of vagal nerve schwannoma ( Figure 10.51.2 ). This was followed by SRS treatment of the residual tumor at 5 months after surgery ( Figure 10.51.3 ).
| Radiosurgery Machine | Gamma Knife |
| Radiosurgery Dose (Gy) | 15, at the 50% isodose line |
| Number of Fractions | 1 |
Initial preoperative MRI: A. Axial T1-weighted with gadolinium, brainstem interface. B. Axial T1-weighted with gadolinium, jugular foramen extent.
Postoperative MRI: Axial T1-weighted with gadolinium, residual tumor within the jugular foramen.
Imaging of the treatment plan. Yellow line is 15 Gy; green line is 8 Gy.
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