2026 Poster Presentations
P107: MANAGEMENT OF A LARGE JUGULAR FORAMEN SCHWANNOMA IN AN ELDERLY PATIENT
Kwaku Obeng, MD; Johnson Deshommes, MD; Thomas Pittman, MD; Willian St. Clair, MD; Mark Mark Fritz, MD; Nicholas Deluga, MD; Zain Guduru, MD; University of Kentucky
Introduction: Jugular foramen schwannomas are rare, benign tumors that pose a diagnostic and therapeutic challenge due to their location and varied clinical presentation. We present a case that underscores the importance of a multidisciplinary approach and definitive histopathological diagnosis in the management of a large jugular foramen schwannoma, particularly when the patient has a complex medical history.
Case Presentation: A 70-year-old male with a history of a gastrointestinal stromal tumor (GIST) presented with vertigo and orthostatic hypotension. Initial imaging revealed a large, heterogeneously enhancing mass in the left cerebellopontine angle extending into the jugular foramen. Given the patient’s history, metastasis was a primary concern, but a schwannoma was also in the differential diagnoses.
Management: The patient underwent suboccipital craniotomy for tumor excision. The final diagnosis was confirmed as a CNS WHO Grade 1 schwannoma through immunohistochemical analysis, which ruled out a metastatic GIST. Post-operatively, the patient developed persistent dysphagia that failed to improved which ultimately required a suspension microlaryngoscopy and balloon dilation. It is worth knowing that dysphagia is a known complication of jugular foramen surgery. He subsequently underwent Gamma Knife radiosurgery for the residual tumor, with Neuroradiology providing crucial imaging for treatment planning. The residual tumor was treated with a dose of 12 Gy to the 50% isodose line.
Conclusion: This case highlights a successful multidisciplinary management strategy for a large jugular foramen schwannoma. The patient's history complicated the initial differential diagnosis, emphasizing the critical role of histopathology in achieving a definitive diagnosis. It also illustrates the importance of a collaborative team—including Neurosurgery, Neuroradiology, Radiation Oncology, and ENT—for surgical planning, management of post-operative complications, and the effective use of radiosurgery for residual disease. This case serves as a valuable teaching tool for the surgical and non-surgical management of these complex skull base lesions.