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Brain Sciences Feb 2024(1) Background: Jugular foramen tumors are complex lesions due to their relationship with critical neurovascular structures within the skull base. It is necessary to... (Review)
Review
(1) Background: Jugular foramen tumors are complex lesions due to their relationship with critical neurovascular structures within the skull base. It is necessary to have a deep knowledge of the anatomy of the jugular foramen and its surroundings to understand each type of tumor growth pattern and how it is related to the surrounding neurovascular structures. This scope aims to provide a guide with the primary surgical approaches to the jugular foramen and familiarize the neurosurgeons with the anatomy of the region. (2) Methods and (3) Results: A comprehensive description of the surgical approaches to jugular foramen tumors is summarized and representative cases for each tumor type is showcased. (4) Conclusions: Each case should be carefully assessed to find the most suitable approach for the patient, allowing the surgeon to remove the tumor with minimal neurovascular damage. The combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach can be performed in a stepwise fashion for the resection of complex jugular foramen tumors.
PubMed: 38391756
DOI: 10.3390/brainsci14020182 -
Cancers Aug 2021Resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve (CN) injury remains difficult. Reoperations in this vital region are associated with severe CN...
BACKGROUND
Resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve (CN) injury remains difficult. Reoperations in this vital region are associated with severe CN deficits.
METHODS
We performed a retrospective analysis at a tertiary neurosurgical center of patients who underwent surgery for JFSs between June 2007 and May 2020. We included nine patients (median age 60 years, 77.8% female, 22.2% male). Preoperative symptoms included hearing loss (66.6%), headache (44.4%), hoarseness (33.3%), dysphagia (44.4%), hypoglossal nerve palsy (22.2%), facial nerve palsy (33.3%), extinguished gag reflex (22.2%), and cerebellar dysfunction (44.4%). We observed Type A, B, C, and D tumors in 3, 1, 1, and 4 patients, respectively. A total of 77.8% (7/9) underwent a retrosigmoid approach, and 33.3% (3/9) underwent an extreme lateral infrajugular transcondylar (ELITE) approach. Gross total resection (GTR) was achieved in all cases. The rate of shunt-dependent hydrocephalus was 22.2% (2/9). No further complications requiring surgical intervention occurred during follow-up. The median follow-up time was 16.5 months (range 3-84 months).
CONCLUSIONS
Considering the satisfying outcome, the GTR of JFSs is feasible in performing well-known skull base approaches. Additional invasive and complicated approaches were not needed. Radiosurgery may be an effective alternative for selected patients.
PubMed: 34439372
DOI: 10.3390/cancers13164218 -
Current Oncology (Toronto, Ont.) Jul 2022Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed... (Review)
Review
BACKGROUND
Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas.
METHODS
PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed.
RESULTS
We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1-C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12-252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1-252).
CONCLUSIONS
Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.
Topics: Cranial Nerve Diseases; Humans; Neoplasm Recurrence, Local; Neurilemmoma; Radiosurgery
PubMed: 35877244
DOI: 10.3390/curroncol29070384 -
World Neurosurgery: X Apr 2023The distinctive bilateral carotid sheaths (CS) reside in the neck region and form part of the deep cervical fasciae. Aspects of the CS anatomy are controversial, most... (Review)
Review
OBJECTIVES
The distinctive bilateral carotid sheaths (CS) reside in the neck region and form part of the deep cervical fasciae. Aspects of the CS anatomy are controversial, most notably its specific attachment sites and fascial makeup, which are key determinants for the spread of tumours and infections and surgical planning. This review aimed to organise the pertinent aspects relating to CS anatomy and pathology, explore their clinical relevance and highlight areas of disagreement in the literature.
METHODS
A narrative review identified key papers relating to CS anatomy, histology, embryology, pathology and clinical and surgical significance using PubMed and Google Scholar. This was supported by a systematic review focused on the fascia forming the CS which was conducted using PubMed, Web of Science and Core Collection which yielded 22 papers.
RESULTS
and Discussion: The CS surrounds the internal carotid artery, internal jugular vein, cranial nerves IX - XII, lymph nodes and nervous plexuses as they course from the jugular foramen superiorly down along into the mediastinum inferiorly. There are contradicting descriptions regarding the CS attachments at the extracranial skull base and within the mediastinum. Author descriptions of the CS fasciae are complex, varied and incongruent. Pathologies affecting the CS include malignancies of the nerves, vascular lesions and utilisation of the CS space as a corridor for the spread of deep neck infections.
CONCLUSION
This paper collates and presents pertinent anatomical and clinical aspects regarding the CS. A proper knowledge of the CS anatomy and structural relationships will optimise surgical approaches and orientation when operating within the region.
PubMed: 37081926
DOI: 10.1016/j.wnsx.2023.100158