Management of a Large Jugular Foramen Schwannoma in a Young Patient

An otherwise healthy 24-year-old female presented with progressive right sided hearing loss. Otoscopy revealed a fleshy pink mass within the middle ear, but otherwise normal cranial nerve examination and nasopharyngeal scope. Audiometric testing demonstrated a mild right conductive hearing loss. MRI demonstrated a 7-cm mass centered at the jugular foramen, with extension into cerebellopontine angle without significant brainstem compression as well as involvement of the carotid space. The lesion was avidly enhancing with central necrotic changes and hypoperfusion on arterial spin labeling, suggesting a diagnosis of schwannoma over paraganglioma. CT demonstrated an intact otic capsule; however, the fallopian canal was nearly completed eroded alongside the remainder of the temporal bone. The tumor tracked along the jugular and hypoglossal foramina with extension into the neck. Reports of clinical outcomes following surgical resection, radiation, or multimodal therapy in this patient population are sparse, particularly in patients with normal pretreatment cranial nerve function. This presentation will focus on the risks and benefits of treatment algorithms and various rehabilitation options. The speaker will initiate discussion with the audience and elicit expert opinion.

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Publication History

Article published online:
07 February 2025