Surgical Approaches and Patient Outcomes in Jugular Foramen Schwannomas: A Meta-Analysis and Systematic Review

Introduction: Jugular foramen schwannomas (JFS) are the second most common non-vestibular schwannoma behind trigeminal. They arise from cranial nerves IX, X, or XI, and although it can be difficult to differentiate which nerve the tumor arises from, the vagus nerve has been the most commonly described. Their complex location and proximity to critical neurovascular structures make resection difficult, with a high risk of postoperative lower cranial nerve deficits. Several surgical approaches have been described to maximize resection while minimizing morbidity. This review analyzes surgical strategies and outcomes in JFS management. Methods: A comprehensive review of the literature was completed using PubMed, Scopus, and Web of Science for terms related to JFS and postoperative outcomes. Exclusion criteria include non-English full-length texts, systematic or literature reviews, and meta-analyses. Results: From 383 initial unique articles, 25 met all inclusion criteria with 636 total patients (n = 83/49/7/497 CN IX/X/XI/Unknown JFS). Mean age at presentation was 40.8 years (53% female). The most common presenting symptoms were hearing loss (29%), dysphagia (23%), hoarseness (20%), and ataxia (15%). Gross total resection (GTR) was reported in 65% of cases, with subtotal or near total resection in the remainder. Recurrence or progression following resection was 8% over a mean follow-up of 35 months. The retrosigmoid approach was the most frequently utilized, followed by far or extreme-lateral, anterolateral, and then combined approach techniques. Combined approach techniques and radiosurgery were commonly employed for subtotal resections. The most common postoperative complications were new or worsening dysphagia, hoarseness, facial nerve palsy, and aspiration pneumonia. Mortality was rare (