Balancing Functional Preservation and Tumor Control of Jugular Foramen Schwannomas: Significance of Subperineural Resection.

Abstract

Jugular foramen schwannoma (JFS) is a rare skull base tumor, and evidence linking resection strategy to neurological outcomes and tumor control remains limited. We evaluated whether subperineural resection (SPR), perineurium-preserving strategy, is associated with improved functional outcomes while maintaining acceptable tumor control. We retrospectively analyzed 24 surgical episodes in 20 patients who underwent JFS resection between March 2011 and June 2025. Resection planes were classified from operative records, surgical videos available for all cases, and imaging as SPR, subcapsular resection (SCR), or extracapsular resection (E). The primary comparison was between non-extracapsular resection (NE; SPR+SCR) and E. Comparisons of SPR with other procedures and with SCR alone were exploratory. Mean percentage extent of resection was similar between NE and E (88% vs. 89%; p = 0.83). New postoperative neurological symptoms were less frequent after NE than after E (14% vs. 70%; p = 0.010), and median postoperative length of stay was shorter (11 vs. 17 days; p = 0.011). Tumor regrowth occurred in 6 NE and 3 E cases (43% vs. 30%; p = 0.68), although follow-up was longer in the E group. Exploratory analyses showed shorter hospitalization, shorter operative time, and less frequent dietary worsening on postoperative day 1 after SPR. Regrowth was less frequent after SPR than after other procedures, but not significantly. SPR based on intraoperative identification of the perineurium may reduce postoperative morbidity in selected patients with JFS. However, the retrospective design, small sample, baseline tumor-volume differences, and heterogeneous follow-up limit conclusions regarding long-term tumor control.