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Journal of Cerebral Blood Flow and... Oct 2023Brain fluid dynamics remains poorly understood with central issues unresolved. In this study, we first review the literature regarding points of controversy, then pilot...
Brain fluid dynamics remains poorly understood with central issues unresolved. In this study, we first review the literature regarding points of controversy, then pilot study if conventional MRI techniques can assess brain fluid outflow pathways and explore potential associations with small vessel disease (SVD). We assessed 19 subjects participating in the Mild Stroke Study 3 who had FLAIR imaging before and 20-30 minutes after intravenous Gadolinium (Gd)-based contrast. Signal intensity (SI) change was assessed semi-quantitatively by placing regions of interest, and qualitatively by a visual scoring system, along dorsal and basal fluid outflow routes. Following i.v. Gd, SI increased substantially along the anterior, middle, and posterior superior sagittal sinus (SSS) (82%, 104%, and 119%, respectively), at basal areas (cribriform plate, 67%; jugular foramina, 72%), and in narrow channels surrounding superficial cortical veins separated from surrounding cerebrospinal fluid (CSF) (96%) (all p < 0.001). The SI increase was associated with higher intraparenchymal perivascular spaces (PVS) scores (Std. Beta 0.71, p = 0.01). Our findings suggests that interstitial fluid drainage is visible on conventional MRI and drains from brain parenchyma via cortical perivenous spaces to dural meningeal lymphatics along the SSS remaining separate from the CSF. An association with parenchymal PVS requires further research, now feasible in humans.
Topics: Humans; Pilot Projects; Brain; Magnetic Resonance Imaging; Stroke
PubMed: 37254892
DOI: 10.1177/0271678X231179555 -
Journal of Neurological Surgery. Part... Jun 2016Introduction Multiple surgical approaches and combinations thereof have been described to gain access to the jugular foramen. In an area laden with important...
Introduction Multiple surgical approaches and combinations thereof have been described to gain access to the jugular foramen. In an area laden with important neurovascular structures, care must be taken in choosing the best surgical approach for treatment of rare pathologies involving this region. Methods This manuscript provides a comprehensive review of the relevant anatomy along with an overview of the various approaches to the jugular foramen. In an attempt to simplify the various concepts, we propose a basic distinction into anterolateral and posterolateral approaches based on the main trajectory targeting the jugular foramen. Conclusion The anatomy surrounding the jugular foramen is exceedingly complex and requires in-depth understanding of skull base and head and neck relationships.
PubMed: 27175322
DOI: 10.1055/s-0035-1567863 -
STAR Protocols Jun 2021The jugular-nodose ganglia contain the sensory peripheral neurons of the vagus nerve, linking visceral organs to the medulla oblongata. Accessing these ganglia in...
The jugular-nodose ganglia contain the sensory peripheral neurons of the vagus nerve, linking visceral organs to the medulla oblongata. Accessing these ganglia in smaller animals without damaging the vascular and neural structures may be challenging, as ganglionic fibers imbed deeply into the carotid sheath, and vagal parasympathetic fibers cross through the interior of the ganglia. We describe a practical protocol for locating and accessing the mouse jugular-nodose ganglia , including instructions for intraganglionic injections and postperfusion dissection. For complete details on the use and execution of this protocol, please refer to Han et al. (2018).
Topics: Animals; Dissection; Female; Jugular Foramina; Male; Mice; Nodose Ganglion
PubMed: 33997807
DOI: 10.1016/j.xpro.2021.100474 -
Journal of Neurosurgery. Case Lessons Dec 2023Jugular foramen dural arteriovenous fistulas (DAVFs) are rare and challenging lesions. Described methods of treatment include embolization and microsurgical...
BACKGROUND
Jugular foramen dural arteriovenous fistulas (DAVFs) are rare and challenging lesions. Described methods of treatment include embolization and microsurgical disconnection through a far lateral transcondylar approach. The authors present the case of a Borden type III jugular foramen DAVF, which was treated with a novel, less invasive retrosigmoid approach with intradural skeletonization and packing of the sigmoid sinus.
OBSERVATIONS
The patient presented with headache and visual field deficit. Neuroimaging demonstrated a right temporal intracerebral hematoma with mass effect. This was due to a Borden type III jugular foramen DAVF with cortical venous reflux into the vein of Labbe secondary to recanalization of a previously thrombosed sigmoid sinus. Microsurgical disconnection was performed via a retrosigmoid approach, in which the sigmoid sinus was identified intradurally at the jugular foramen. The sigmoid sinus was isolated by drilling at the pre- and retrosigmoid spaces to permit packing and clip ligation. Postoperative angiography revealed complete occlusion of the DAVF.
LESSONS
Jugular foramen DAVFs are rare entities, which have been traditionally treated through a far lateral transcondylar approach. An intradural retrosigmoid approach is a safe, less invasive alternative, which involves less soft tissue and bony dissection and does not have the associated morbidity of craniocervical instability and hypoglossal neuropathy.
PubMed: 38079627
DOI: 10.3171/CASE23549 -
The Journal of International Advanced... Aug 2019This study aimed to compare the right and left sides of the carotid foramen (CF) to determine its precise location according to certain anatomical landmarks. (Comparative Study)
Comparative Study
OBJECTIVES
This study aimed to compare the right and left sides of the carotid foramen (CF) to determine its precise location according to certain anatomical landmarks.
MATERIALS AND METHODS
Twenty human dry skulls were included in the study. A digital caliper and a digital image analysis software were used to obtain direct anatomical numerical values. Then, the same parameters on dry skulls were assessed with computed tomography (CT).
RESULTS
CF was found to be round shaped (62.5%), oval shaped (32.5%), and tear-drop shaped (5%). In all cases, the position of CF was seen as just postero-laterally of the foramen lacerum. According to the jugular foramen, CF was seen to be anterior in 85% and antero-medial in 15% of the cases. Regarding the morphometric values of the surface area, the length and width of CF were observed to be 37.86±11.24 mm2, 8.02±1.09 mm, and 6.86±0.90 mm at direct anatomical measurements and 39.69±10.07 mm2, 7.89±1.14 mm, and 6.41±0.90 mm at CT, respectively. The angles between the supramastoid crest-CF-zygoma root and the supramastoid crest-CF-mastoid process were determined as 37.11±6.87º and 42.22±6.40º at direct anatomical measurements and 36.59±4.94º and 43.71±4.55º at CT, respectively.
CONCLUSION
A significant difference in sides was not observed in relation with the numerical data of CF obtained from CT or from direct anatomical measurements of dry skulls. Moreover, a significant difference was not found between radiological and direct anatomical measurements. Therefore, precise radiological assessment of this region by an experienced neuroradiologist may be assumed as a fundamental need for successful surgeries of the skull base, in addition to thorough anatomical knowledge of neurootologists and neurosurgeons.
Topics: Anatomic Landmarks; Cadaver; Carotid Artery, Internal; Female; Humans; Male; Skull Base; Temporal Bone; Tomography, X-Ray Computed
PubMed: 31347511
DOI: 10.5152/iao.2019.6154 -
Brain Sciences Sep 2022Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild...
Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild tinnitus, headache, and dizziness, together with preoperative related imaging, was diagnosed with a left intra-extracranial communicating jugular foramen lesion in November 2015 and accepted an initial operation for the intracranial tumor by retrosigmoid approach. The pathologic report was paraganglioma. In November 2021, a subtotal resection of the extracranial tumor was conducted for prominent lower cranial nerves (LCNs) deficit and middle ear involvement by infratemporal approach. In patients with IECJFP accompanied by LCNs deficit and middle ear involvement, an initial surgery for extracranial lesion and a second procedure for intracranial tumor were appropriate. However, the first operation for the intracranial lesion was preferred in IECJFP cases without LCNs deficit and middle ear involvement, as it could remove compression to the neurovascular structure and brain stem, clarify a pathological diagnosis, avoid a CSF leak, and prevent a severe neurological disorder from extracranial lesion excision. Subtotal resection of the extracranial tumor would be performed when lesion became larger combined with obvious LCNs disorder and tympanic cavity involvement. Consideration of specific staged surgical strategy for IECJFP in accordance with preoperative LCNs deficit and tympanic cavity involvement could prevent critical postoperative neurological deficit and improve quality of life in the long term.
PubMed: 36138993
DOI: 10.3390/brainsci12091257 -
SAGE Open Medical Case Reports 2024Collet-Sicard syndrome is a rare neurological disorder caused by injury to the cranial nerve pairs IX, X, X, and XII. The author reports on a previously fit 27-year-old...
Collet-Sicard syndrome is a rare neurological disorder caused by injury to the cranial nerve pairs IX, X, X, and XII. The author reports on a previously fit 27-year-old man who presented with dysphagia, choking on drinking water, hoarseness, weakness when turning the neck and shrugging the shoulders, and unexplained weight loss. Enhanced magnetic resonance imaging indicated a space-occupying lesion at the right jugular foramen. After surgical resection, the pathologic findings suggested a paraganglioma of the right jugular foramen and confirmed the diagnosis of Collet-Sicard syndrome. After postoperative treatment with a combination of acupuncture and modern medicine, the patient's symptoms significantly improved. This article analyzes previous literature regarding Collet-Sicard syndrome etiology and reports the case of a patient with a rare etiology, whose prognosis improved significantly after treatment with a combination of acupuncture and modern medicine.
PubMed: 38737561
DOI: 10.1177/2050313X241249613 -
Turkish Archives of Otorhinolaryngology Dec 2021We aimed to investigate the mastoid emissary vein (MEV) canal incidence and to identify its relationship with jugular bulb (JB) and sigmoid sulcus anatomical variations.
OBJECTIVE
We aimed to investigate the mastoid emissary vein (MEV) canal incidence and to identify its relationship with jugular bulb (JB) and sigmoid sulcus anatomical variations.
METHODS
We retrospectively reviewed 1,300 patients with temporal bone computed tomography (CT) scans in January 2016 to March 2020. The presence and the diameter of the MEV canal, and the anatomical variations of the sigmoid sulcus and the JB were reviewed by two radiologists. High riding JB, JB diverticulum, dehiscent JB, and anterior and lateral protrusion of the sigmoid sulcus were evaluated. All variables were summarized using descriptive statistics. The differences between the groups for categorical data were investigated using the chi-square test. Numeric variables were compared with the Mann-Whitney and the Kruskal-Wallis tests. Logistic regression models were constructed.
RESULTS
The study included 1,269 patients of whom 694 were female (54.7%) and 575 were male (45.3%). Their mean age was 39.01±18.47. Among them 915 (72.1%) had the right and 871 (68.6%) had the left MEV canal. Men were more likely to have the MEV canal on both sides. The presence of the right and left MEV canals was associated with the ipsilateral dominant JB/sigmoid sulcus. The left MEV canal was associated with the left high riding JB and right dehiscent JB.
CONCLUSION
This is the largest patient population reported in the literature and allows a more precise estimate of the MEV canal incidence. We also classified the diameter of the MEV canal to identify clinically relevant, prominent MEV incidence. This is also the first study to demonstrate a relationship between the presence of the MEV canal, and the JB and sigmoid canal variations. Since both the prominent MEV and the JB variations may be symptomatic, knowing this association between them may have clinical relevance.
PubMed: 35262041
DOI: 10.4274/tao.2021.2021-4-26 -
Surgical Neurology International 2022Primary jugular fossa meningiomas are one of the rarest subgroups of meningioma, with an estimated incidence of 0.7-4.3% of all skull base meningiomas. Indeed, only 145...
BACKGROUND
Primary jugular fossa meningiomas are one of the rarest subgroups of meningioma, with an estimated incidence of 0.7-4.3% of all skull base meningiomas. Indeed, only 145 cases of jugular foramen meningiomas have been reported in the literature to date. While meningiomas of this region are typically referred to as "jugular foramen meningiomas," we make a distinction between meningiomas arising directly from the foramen itself, and those arising from the jugular tubercle. Jugular tubercle meningiomas, therefore, represent an even smaller subset of an already uncommon location for meningiomas. The jugular tubercle is the upper surface of the lateral parts of occipital bone presents an oval eminence, which overlies the hypoglossal canal and is sometimes crossed by an oblique groove for the glossopharyngeal, vagus, and accessory nerves. Only eight cases in the anterior foramen magnum lesions excised by a far lateral retrosigmoid approach have been described. The aim of this video article is to describe the surgical approach the senior author used to access lesion involving the jugular tubercle.
CASE DESCRIPTION
In this surgical video, we present a case of a 56-year-old female presented to our hospital with dizziness, headache, lower cranial nerves deficits, and lower limbs weakness. On exam, she was noted to have a left paraparesis, 9, 10, and 11 nerves palsies. An MRI scan demonstrated a mass in the region of the left jugular tubercle. Frozen section was suggestive of meningioma and our patient underwent a successful near total resection with no permanent neurologic sequelae.
CONCLUSION
Jugular tubercle meningiomas are one of the rarest subgroups of meningioma. The described modified retrosigmoid approach provides outstanding access to the entire ventrolateral brainstem and cerebellopontine angle, with reduced approach related morbidity.
PubMed: 35855117
DOI: 10.25259/SNI_361_2022 -
Journal of Neurological Surgery. Part... Jun 2019Meningiomas of the cerebellopontine angle (CPA) are the second most frequent lesions related to this region (around 10-15%), 1 being the vestibular schwannomas the first...
Meningiomas of the cerebellopontine angle (CPA) are the second most frequent lesions related to this region (around 10-15%), 1 being the vestibular schwannomas the first (around 85%). This lesions arise from the dura of the petrosal surface of the temporal bone, lateral to the trigeminal nerve ( Fig. 1 ). Variable attachment sites and directions of growth make different clinical presentations and operative challenges. This pathologies can be classified accordingly to they're extension related to the internal acoustic meatus in: postmeatal, premeatal, and large meningiomas with pre- and postmeatal extension ( Fig. 2 ). We present an operative video performed by the senior author (L.A.B.B.). A 64-year-old woman with 3 months of complaint of left facial pain on the V2 territory of the trigeminal nerve and diplopia secondary to VI nerve paresis. Magnetic resonance imaging (MRI) scans demonstrated a large homogeneous enhancing lesion at the left CPA, extending pre- and postmeatal and from the tentorium cerebeli to the jugular foramen region, highly suggestive of CPA meningioma. Surgery was offered to the patient as a first option. In our point of view, neurophysiological monitoring with somatosensory and motor evoked potentials is mandatory while dealing with such large tumors around the CPA. The surgery was performed after a standard retrosigmoid craniotomy, with careful dissection and debulking while devascularizing the tumor from its petrosal attachment. Near-total resection was achieved and the patient had a remarkable postoperative outcome with improvement of the diplopia and facial pain with preservation of VII and VIII nerves function. The pathology demonstrated a grade 1 meningioma. The link to the video can be found at: https://youtu.be/UVVyEhq8Fu0 .
PubMed: 31143604
DOI: 10.1055/s-0038-1677493