Jugular foramen schwannoma

Last revised by Ryan Thibodeau on 31 Aug 2023

Jugular foramen schwannomas are a rare type of intracranial schwannoma that presents as a jugular fossa mass involving the jugular foramen.

Patients without neurofibromatosis type 2 (NF2) tend to present between the 3rd to 6th decades of life. There is a recognized female predilection 1. The tumors can have a wide variety of clinical presentations.

They can arise from cranial nerves IX, X or XI, with IX being the most common 3.

  • usually well-demarcated

  • tend to be iso to hypoattenuating to brain parenchyma 3

  • may show expansion and remodeling of the affected jugular foramen

  • may have a characteristic dumbbell configuration

Signal characteristics are those of a schwannoma:

  • T1: typically low signal

  • T2: typically high signal

    • cystic degeneration may be seen in larger tumors

  • T1 C+ (Gd)

    • smaller lesions demonstrate intense homogeneous enhancement

    • larger lesions tend to have heterogeneous enhancement

As with most schwannomas, they tend to be slow-growing tumors. Surgical resection is often the treatment of choice.

For a full list of differentials see the article on jugular fossa masses. Considerations in this location include:

  • paraganglioma: jugular paraganglioma

    • “salt and pepper” appearance on MRI with intense contrast enhancement and multiple small flow voids

      • vascular schwannomas may have peripheral flow voids but should not have internal flow voids

    • if large, irregular erosion of the margin of the jugular foramen, with decalcification or destruction of the surrounding bone

    • possible invasion of jugular bulb/vein with intraluminal growth (compared to compression by schwannomas)

  • meningioma around the jugular foramen 2

  • metastatic malignant tumors or lymphoma

    • may be indistinguishable from schwannoma when involving jugular foramen

    • most likely destruction of surrounding bone, with less sharply marked borders

ADVERTISEMENT: Supporters see fewer/no ads