Jugular foramen schwannoma

Case contributed by Dr Mauricio Macagnan

Presentation

Occipital headache and dizziness. No trauma.

Patient Data

Age: 30 years old
Gender: Male
MRI

Extra-axial mass lesion located in the cistern bulb left of the cerebellum apparently extending into the jugular foramen. Slightly heterogeneous signal in T2, post gadolinium enhancement, with tiny likely cystic areas in between. The mass exerts minimal mass effect on the left middle cerebellar peduncle.

CT

CT: extra-axial expansive lesion isodense, located in the left bulbocerebelar cistern with moderate enhancement by means of intravenous iodinated contrast, situated adjacent to the same jugular foramen.

CT Angiography: The extra-axial mass located adjacent to the jugular foramen, but no evidence of bone erosion or vascular invasion signals and demonstrates discreet contrast enhancement.

Fusion of CT and MRI images T1C + shows mass lesion located in the left cerebellar cistern bulb, adjacent to the jugular foramen, with emphasis on the means of contrast evidenced in sequence T1 C + in MRI.

CT

Post-Op

Postsurgical changes in the posterior fossa, left (schwannoma resection of jugular foramen), with no evidence of tumor recurrence or remnant.

The result of the pathological examination demonstrated the lesion being a Schwannoma.

Case Discussion

Jugular foramen masses are uncommon, where the paragangliomas are the most common tumors, followed by schwannomas. Schwannomas are benign, slow growth and its origin is most commonly from the cranial sensory nerves. Most commonly affects patients between the third and sixth decades of life with an increased frequency in women.

When bilateral often has association with neurofibromatosis Type II (NF2). When located in the jugular foramen, present clinically with hearing loss, ataxia and headache, common with the changes of the cranial nerves IX, X and XI.

The main differential diagnosis should remember paraganglioma - jugulare tumor glomus and meningioma.

Surgical excision is the treatment option of choice. In this case, the patient underwent surgical resection with improvement in symptoms and no tumor recurrence.

This case was kindly provided by Dr Rodrigo Dias Duarte.

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Case information

rID: 46026
Case created: 17th Jun 2016
Last edited: 18th Jul 2016
Inclusion in quiz mode: Included

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