Surgical management of transcranial hypoglossal schwannomas

Hypoglossal schwannomas are rare cranial base neoplasms that originate in the posterior cranial fossa and extend through the hypoglossal canal in a dumbell fashion. Recent experience with this unusual neoplasm prompted a search for an operative approach to remove the lesion with a minimization of postoperative morbidity from bleeding and iatrogenic cranial nerve deficits. This report describes the use of the transcondylar approach with monitoring of the lower basal cranial nerves to totally remove a transcranial hypoglossal schwannoma with no new-onset cranial nerve palsies. The regional anatomy of the hypoglossal nerve and canal is reviewed in relation to the operative approach.