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Head & Neck Oct 2021Lesions arising from the upper parapharyngeal space (UPPS) often involved the jugular foramen region (JFR), occasionally extending into the posterior cranial fossa. This...
Lesions arising from the upper parapharyngeal space (UPPS) often involved the jugular foramen region (JFR), occasionally extending into the posterior cranial fossa. This study aims to investigate the surgical anatomy of the JFR and UPPS from the perspective of an expanded endoscopic approach (EEA), tracing the lower cranial nerves from their extracranial foramina to the UPPS. Six cadaveric specimens (12 sides) underwent a transpterygoid EEA to expose the JFR and UPPS. Distances from the medial pterygoid plate (MPP) to the internal carotid artery (ICA), hypoglossal canal (HC), and jugular tubercle (JT) were measured on anonymized Computed tomography angiography images previously obtained from 30 patients with pulsatile tinnitus. Full access to the JFR, and its medial, superior, and anterior aspects, could be adequately achieved via an EEA. Upon exiting the jugular foramen, the glossopharyngeal nerve courses posterior to the ICA, traveling inferiorly into the UPPS between ICA and IJV. The vagus nerve is in close proximity to the hypoglossal nerve traveling posterior to the ICA. The accessory nerve courses lateral to the vagus nerve, running posterior to the IJV. The minimal distances from the MPP to ICA, HC, and JT were 2.52 ± 0.34, 2.86 ± 0.36, and 3.18 ± 0.33 cm, respectively. This anatomical study strongly suggests the feasibility of using an EEA to access to the medial, superior, and anterior aspects of the jugular foramen and the adjacent UPPS.
Topics: Cadaver; Cranial Nerves; Humans; Nose; Parapharyngeal Space; Sphenoid Bone
PubMed: 34165854
DOI: 10.1002/hed.26781 -
Operative Neurosurgery (Hagerstown, Md.) Apr 2023Schwannoma that arises in the jugular foramen (JF) represents an important challenge for neurosurgeons for its precise location, extension, and neurovascular...
BACKGROUND
Schwannoma that arises in the jugular foramen (JF) represents an important challenge for neurosurgeons for its precise location, extension, and neurovascular relationship. Nowadays, different managements are proposed. In this study, we present our experience in the treatment of extracranial JF schwannomas (JFss) with the extreme lateral juxtacondylar approach (ELJA).
OBJECTIVE
To present our experience in the treatment of extracranial JF schwannomas (JFss) with the ELJA.
METHODS
Between January 2013 and January 2017, 12 patients with extracranial JFs underwent surgery by ELJA. All lesions were type C of the Samii classification. Indocyanine green videoangiography was used to evaluate the relationship between the internal jugular vein and the tumor and to control the presence of spasm in the vertebral artery.
RESULTS
A complete exeresis was achieved in 9 patients while in 3 patients, it was subtotal. The complete regression of symptoms was obtained in 7 patients with a total resection. The remaining cases experienced a persistence of symptoms.
CONCLUSION
The success of this surgery is achieved through a management that starts from the patient's position. We promote an accurate evaluation of JFs through the Samii classification: Type C tumors allow the use of ELJA that reduces surgical complications. Furthermore, we recommend the use of indocyanine green videoangiography to preserve the vessels and prevent vasospasm.
Topics: Humans; Jugular Foramina; Indocyanine Green; Head and Neck Neoplasms; Neurilemmoma; Microsurgery
PubMed: 36701746
DOI: 10.1227/ons.0000000000000535 -
Frontiers in Surgery 2020The jugular foramen remains one of the most complex regions of the human body. Approaching lesions in this area requires extensive anatomical knowledge and experience,... (Review)
Review
The jugular foramen remains one of the most complex regions of the human body. Approaching lesions in this area requires extensive anatomical knowledge and experience, due to the many critical neurovascular structures passing through or around the jugular foramen. Here, we present a concise review of the microsurgical anatomy of the jugular foramen in relation to the craniocervical approach.
PubMed: 32500078
DOI: 10.3389/fsurg.2020.00027 -
Journal of Neurological Surgery. Part... Dec 2019Glomus tumors, also called paragangliomas, are challenging lesions, demanding accurate knowledge of complex anatomy and pertinent approaches. We present the case of a...
Glomus tumors, also called paragangliomas, are challenging lesions, demanding accurate knowledge of complex anatomy and pertinent approaches. We present the case of a 39-year-old male presenting with headache, vertigo, tinnitus, hearing loss, and hoarseness. Neurological assessment showed facial paralysis House-Brackmann IV and lower cranial nerves deficits. Preoperative magnetic resonance imaging (MRI) demonstrated two large lesions, suggestive of a glomus jugulare, and carotid body paragangliomas. Considering worsening of the symptoms and the important mass effect of both lesions over the neurovascular structures, microsurgical excision was offered, after preoperative tumor embolization. We preferred to approach both lesions in the same operation, starting by the cervical tumor. Initially there was not an easily identifiable dissection plane between the tumor and the carotid artery, but it was achieved after performing a subadventitial dissection, being possible to resect the entire lesion. The jugular foramen lesion was approached through a postauricular transtemporal approach, skeletonizing the sigmoid sinus, jugular bulb, and facial nerve, following a complete mastoidectomy. The tumor, extending to the intradural compartment, middle ear, internal auditory canal, petrous internal carotid artery, and internal jugular vein was completely removed. Postoperative MRI demonstrated complete resection of both lesions, and pathology confirmed to be paragangliomas. In the immediate postoperative period, the facial paralysis evolved to House-Brackmann grade VI, improving to grade III during follow-up. The patient underwent a vocal cord medialization in order to improve voice quality and swallowing. These are challenging lesions and extensive laboratory training is mandatory to be familiarized with the regional anatomy and its various surgical approaches. The link to the video can be found at: https://youtu.be/gA_ckwFq_9c .
PubMed: 31750072
DOI: 10.1055/s-0039-1695055 -
Journal of Neurosurgical Sciences Jun 2018Endoscopic endonasal access to the jugular foramen and occipital condyle - the transcondylar-transtubercular approach - is anatomically complex and requires detailed... (Review)
Review
Endoscopic endonasal access to the jugular foramen and occipital condyle - the transcondylar-transtubercular approach - is anatomically complex and requires detailed knowledge of the relative position of critical neurovascular structures, in order to avoid inadvertent injury and resultant complications. However, access to this region can be confusing as the orientation and relationships of osseous, vascular, and neural structures are very much different from traditional dorsal approaches. This review aims at providing an organizational construct for a more understandable framework in accessing the transcondylar-transtubercular window. The region can be conceptualized using a three-vector coordinate system: vector 1 represents a dorsal or ventral corridor, vector 2 represents the outer and inner circumferential anatomical limits; in an "onion-skin" fashion, key osseous, vascular, and neural landmarks are organized based on a 360-degree skull base model, and vector 3 represents the final core or target of the surgical corridor. The creation of an organized "global-positioning system" may better guide the surgeon in accessing the far-medial transcondylar-transtubercular region, and related pathologies, and help understand the surgical limits to the occipital condyle and jugular foramen - the ventral posterolateral corridor - via the endoscopic endonasal approach.
Topics: Humans; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Skull Base
PubMed: 29527888
DOI: 10.23736/S0390-5616.18.04356-4 -
Journal of Neuroimaging : Official... May 2022Differentiation of meningiomas, paragangliomas, and schwannomas in the cerebellopontine angle and jugular foramen remains challenging when conventional MRI findings...
BACKGROUND AND PURPOSE
Differentiation of meningiomas, paragangliomas, and schwannomas in the cerebellopontine angle and jugular foramen remains challenging when conventional MRI findings are inconclusive. This study aimed to assess the clinical utility of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) findings for tumor type differentiation and to identify the most significant diagnostic parameters.
METHODS
This retrospective study included 57 patients with pathologically confirmed meningiomas, paragangliomas, and schwannomas, diagnosed between January 2018 and August 2021. DWI and DCE-MRI were obtained before surgery. The apparent diffusion coefficient (ADC) and DCE-MRI parameters were calculated. The Kruskal-Wallis H test and post hoc test with Bonferroni correction and receiver operating characteristic curve were used for statistical analysis.
RESULTS
There were 20 meningiomas (6 men; 62.3 ± 17.8 years), 23 paragangliomas (3 men; 51.6 ± 17.0 years), and 14 schwannomas (7 men; 37.7 ± 20.0 years). V showed a significant difference in each comparison (p < .001, <.001, and <.001, respectively), V showed significant differences both in meningiomas and paragangliomas, and paragangliomas and schwannomas (p < .001 and .017, respectively), and K showed significant differences both in meningiomas and paragangliomas, and meningiomas and schwannomas (p = .0018 and <.001, respectively), though there was no significant difference in ADC. V diagnostic performance values for each pair of tumors were area under the curve of 0.89-1.00, with cutoff values of 0.14-0.27.
CONCLUSION
DCE-MRI can provide promising parameters to differentiate meningiomas, paragangliomas, and schwannomas in the cerebellopontine angle and jugular foramen.
Topics: Cerebellopontine Angle; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Humans; Jugular Foramina; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Neurilemmoma; Paraganglioma; Retrospective Studies
PubMed: 34936708
DOI: 10.1111/jon.12959 -
World Neurosurgery Apr 2023The far lateral approach provides wide surgical access to the lower third of the clivus, pontomedullary junction, and anterolateral foramen magnum and rarely requires...
Posterolateral Routes to the Skull Base, Craniocervical Junction, and Jugular Foramen-The Far Lateral Transcondylar Approach and Combined Transpetrosal Transcervical Approaches.
The far lateral approach provides wide surgical access to the lower third of the clivus, pontomedullary junction, and anterolateral foramen magnum and rarely requires craniovertebral fusion. The most common indications for this approach are posterior inferior cerebellar artery and vertebral arteryaneurysms, brainstem cavernous malformations, and tumors anterior to the lower pons and medulla, including meningiomas of the anterior foramen magnum, schwannomas of the lower cranial nerves, and intramedullary tumors at the craniocervical junction. We provide a stepwise description of how we perform the far lateral approach, as well as how to combine the far lateral approach with other skull base approaches, including the subtemporal transtentorial approach, for lesions involving the upper clivus; the posterior transpetrosal approach, for lesions involving the cerebellopontine angle and/or petroclival region; and/or lateral cervical approaches, for lesions involving the jugular foramen or carotid sheath regions.
Topics: Humans; Jugular Foramina; Skull Base; Cranial Fossa, Posterior; Foramen Magnum; Meningeal Neoplasms
PubMed: 37012729
DOI: 10.1016/j.wneu.2022.11.053 -
The Indian Journal of Radiology &... Mar 2022There are many types of neoplasms in or around the foramen of Luschka (FL), and definitive diagnosis in some cases requires knowledge of imaging findings. The uncommon... (Review)
Review
There are many types of neoplasms in or around the foramen of Luschka (FL), and definitive diagnosis in some cases requires knowledge of imaging findings. The uncommon and challenging neoplasms with FL involvement considered in this study are exophytic brainstem glioma, primary glioblastoma of the cerebellopontine angle (CPA), primary anaplastic ependymoma of the CPA, choroid plexus papilloma of the FL, solitary FL choroid plexus metastasis, extraskeletal myxoid chondrosarcoma of the jugular foramen, paraganglioma of the jugular foramen, exostosis of the jugular foramen, psammomatous meningioma in the lateral cerebellar medullary cistern, epidermoid tumor of the fourth ventricle, and a hypoglossal schwannoma. These neoplasms may have overlapping clinical and imaging features, but some have relatively distinct imaging features. Knowledge of the key clinical and magnetic resonance imaging features of these unusual lesions with FL involvement is important for radiologists to improve diagnostic ability and to assist the referring physician in the appropriate management of the patient.
PubMed: 35722640
DOI: 10.1055/s-0042-1743113 -
Clinical Imaging Apr 2023Differentiation of paragangliomas and meningiomas can be a challenge. This study aimed to assess the utility of dynamic susceptibility contrast perfusion MRI (DSC-MRI)...
PURPOSE
Differentiation of paragangliomas and meningiomas can be a challenge. This study aimed to assess the utility of dynamic susceptibility contrast perfusion MRI (DSC-MRI) to distinguish paragangliomas from meningiomas.
METHODS
This retrospective study included 40 patients with paragangliomas and meningiomas in the cerebellopontine angle and jugular foramen region between March 2015 and February 2022 in a single institution. Pretreatment DSC-MRI and conventional MRI were performed in all cases. Normalized relative cerebral blood volume (nrCBV), relative cerebral blood flow (nrCBF), relative mean transit time (nrMTT), and time to peak (nTTP) as well as conventional MRI features were compared between the 2 tumor types and between meningioma subtypes as appropriate. Receiver operating characteristic curve and multivariate logistic regression analysis were performed.
RESULTS
Twenty-eight meningiomas including 8 WHO grade II meningiomas (12 males, 16 females; median age 55 years) and 12 paragangliomas (5 males, 7 females; median age 35 years) were included in this study. Paragangliomas had a higher rate of cystic/necrotic changes (10/12 vs 10/28; P = 0.014), a higher rate of internal flow voids (9/12 vs 8/28; P = 0.013), higher nrCBV (median 9.78 vs 6.64; P = 0.04), and shorter nTTP (median 0.78 vs 1.06; P < 0.001) than meningiomas. There was no difference in conventional imaging features and DSC-MRI parameters between meningioma subtypes. nTTP was identified as the most significant parameter for the 2 tumor types in the multivariate logistic regression analysis (P = 0.009).
CONCLUSIONS
In this small retrospective study, DSC-MRI perfusion differences were observed between paragangliomas and meningiomas, but not between grade I and II meningiomas.
Topics: Male; Female; Humans; Middle Aged; Adult; Meningioma; Retrospective Studies; Cerebellopontine Angle; Jugular Foramina; Magnetic Resonance Imaging; Meningeal Neoplasms
PubMed: 36801537
DOI: 10.1016/j.clinimag.2022.12.014 -
World Neurosurgery Sep 2020The aim of this study was to define the types, prevalences, and diameters of dural septations (DSs) on the inner surface of the jugular foramen (JF) and to describe the...
OBJECTIVE
The aim of this study was to define the types, prevalences, and diameters of dural septations (DSs) on the inner surface of the jugular foramen (JF) and to describe the distances between the JF, the glossopharyngeal nerve (cranial nerve [CN] IX), vagus nerve (CN X), and accessory nerve (CN XI), the internal acoustic meatus, and nearby surgical landmarks on cadaveric heads.
METHODS
Seventeen adult (9 men and 8 women) formalin-fixed cadaveric heads were used to analyze the types and prevalence of DS bilaterally. Diameters and distances between the DS and the adjacent CNs (CN IX-XI) were measured by digital microcaliper. The multiple t test (SPSS version 25) was used to analyze the comparison between both sides via diameters, numbers, distance, length, and thickness of DS.
RESULTS
The most frequent type of DS was type I (62.5%, right; 56.3%, left), followed by type II (18.8%, right; 25%, left), type III (12.5%, right; 6.3%, left), and type IV (6.3%, right; 12.5%, left). The mean diameter of the septum was 0.6-1 mm, and the mean length of the dural septa was 4.01 mm (right) and (3.83 mm) left. The difference in the length and thickness of the DS between the genders was statistically significant on both sides (P < 0.05). The DS-CN X and DS-JF distances of women were greater than those of men on the right side (P < 0.05).
CONCLUSIONS
The significant differences between dural septum types on the 2 sides of the body may indicate asymmetric location or a variant emerging site of CNs in the same individual.
Topics: Adult; Cadaver; Dura Mater; Female; Humans; Jugular Foramina; Male; Spinal Canal
PubMed: 32522647
DOI: 10.1016/j.wneu.2020.05.271