'Interdural' surgical strategy for lower cranial nerve neurinomas - a report of 14 cases.

Abstract: Objective We describe the dural relationships and its surgical implications for large lower cranial nerve neurinomas. The study is based on a surgical experience with 14 cases. Material and methods During the period January 2014 to December 2019, 14 consecutive cases with large lower cranial nerve neurinomas were surgically treated with the aim of radical tumor resection. Results There were 9 males and 5 females and the ages ranged from 17 to 65 years. All patients were operated in a single stage. The principal surgical observation was that the entire extent of tumor that included intracranial, jugular fossa and the extracranial component were within the ‘dural’ confines and the tumor adjoining critical neural and vascular structures were displaced around the dome of the tumor. Radical surgical resection was achieved in all cases. During the follow-up period that ranged from 3 to 71 months (average 32 months) no symptomatic recurrence was observed and no patient needed reoperation. At the time of last clinical follow-up, the lower cranial nerve function in all patients was better than at the time of presentation. Conclusion The ‘dural’ cover of the lower cranial nerve neurinomas forms a strong and reliable plain of compartmentalization and allows safe tumor resection.