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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 -
Neuro-Chirurgie Nov 2019Patients with syndromic faciocraniosynostosis due to the mutation of the fibroblast growth factor receptor (FGFR) 2 gene present premature fusion of the coronal sutures... (Review)
Review
BACKGROUND
Patients with syndromic faciocraniosynostosis due to the mutation of the fibroblast growth factor receptor (FGFR) 2 gene present premature fusion of the coronal sutures and of the cranial base synchondrosis. Cerebrospinal fluid (CSF) circulation disorders and cerebellar tonsil prolapse are frequent findings in faciocraniosynostosis.
OBJECTIVE
We reviewed the medical literature on the pathophysiological mechanisms of CSF disorders such as hydrocephalus and of cerebellar tonsil prolapse in FGFR2-related faciocraniosynostosis.
DISCUSSION
Different pathophysiological theories have been proposed, but none elucidated all the symptoms present in Apert, Crouzon and Pfeiffer syndromes. The first theory that addressed CSF circulation disruption was the constrictive theory (cephalocranial disproportion): cerebellum and brain stem are constricted by the small volume of the posterior fossa. The second theory proposed venous hyperpressure due to jugular foramens stenosis. The most recent theory proposed a pressure differential between CSF in the posterior fossa and in the vertebral canal, due to foramen magnum stenosis.
Topics: Acrocephalosyndactylia; Arnold-Chiari Malformation; Craniosynostoses; Humans; Hydrocephalus; Receptor, Fibroblast Growth Factor, Type 2
PubMed: 31525395
DOI: 10.1016/j.neuchi.2019.09.001 -
European Archives of... Oct 2019Endolymphatic sac tumor (ELST) is a rare, slow-growing, and low-grade malignant tumor arising from the endolymphatic sac in the posterior petrous bone. The purpose of...
PURPOSE
Endolymphatic sac tumor (ELST) is a rare, slow-growing, and low-grade malignant tumor arising from the endolymphatic sac in the posterior petrous bone. The purpose of this study is to describe the clinical and radiologic features, and investigate the clinicoradiologic correlation of ELST.
METHODS
We retrospectively reviewed the clinical, computed tomography (CT), magnetic resonance imaging (MRI), and pathologic findings of 14 patients with 15 ELSTs.
RESULTS
Patients comprised of eight women and six men with a mean age of 42.3 years at the time of diagnosis and 35.2 years at the time of initial symptoms. The mean interval between initial symptoms and diagnosis was 84.7 months. The most frequent cochleovestibular symptom was hearing loss in 14 patients (100%); other cochleovestibular symptoms were tinnitus in eight patients (57.1%), vertigo in three patients (21.4%), and aural fullness in three patients (21.4%). Ten patients (71.4%) presented with facial paralyses and five patients (14.3%) presented lower cranial nerve deficits. CT findings revealed spiculated, stippled, or reticular high density within the tumors. The lesions involved mastoid cells, vertical facial nerve canal, semicircular canal, cochlea, tympanum, jugular foramen, internal auditory canal, or petrous apex. On the available MRI, all the eight lesions showed patchy and/or speckled hyperintensity on unenhanced T1WI. Five lesions showed flow voids on T2WI and T1WI. Three lesions had blood fluid levels within cysts.
CONCLUSION
CT and MRI findings of ELSTs are associated with clinical features. Imaging tests should be performed to identify ELSTs early and ensure greater potential for hearing preservation in patients with cochleovestibular symptoms.
Topics: Adult; Ear Neoplasms; Early Diagnosis; Endolymphatic Sac; Female; Hearing Loss; Humans; Magnetic Resonance Imaging; Male; Petrous Bone; Retrospective Studies; Tinnitus; Tomography, X-Ray Computed; Vertigo
PubMed: 31197530
DOI: 10.1007/s00405-019-05511-8 -
CNS Neuroscience & Therapeutics Nov 2022Differentiating between acquired stenosis (pathologic) and anatomical slenderness (physiologic) of internal jugular vein (IJV) remain ambiguous. Herein, we aimed to...
BACKGROUND AND PURPOSES
Differentiating between acquired stenosis (pathologic) and anatomical slenderness (physiologic) of internal jugular vein (IJV) remain ambiguous. Herein, we aimed to compare the similarities and differences between the two entities.
METHODS
Patients who underwent head and neck computer tomography (CT) and brain magnetic resonance imaging (MRI) were enrolled in this case-control study from January 2016 through October 2021.
RESULTS
1487 eligible patients entered final analysis totally. 803 patients had bilateral IJVs imaging without IJV stenosis-related symptoms and presented in three ways: right IJV slenderness (10.5%, n = 85), left IJV slenderness (48.4%, n = 388), and symmetric IJVs (41.1%, n = 330). In patients with asymmetric IJVs, their bilateral jugular foramina were also asymmetric. All involved asymmetric IJVs presented as slenderness without surrounding abnormal collaterals and credible cloudy-like white matter hyper-intensity (WMH). Their cerebral arterial perfusion statuses on brain MR-PWI maps were normal. In contrast, the major patients with IJV stenosis presented with signs and symptoms such as headaches, head noise, etc. In CE-MRV maps, local stenosis of the IJV was surrounded by abnormal venous collaterals in contrast to the lack of abnormal venous collaterals for patients with IJV slenderness. And in CTV maps, the caliber of jugular foramina was mismatched with the transverse diameter of IJV. Moreover, in MRI maps of most of these patients, a cloudy-like WMHs were distributed symmetrically in bilateral periventricular and/or centrum semi vales. These patients also had symmetrical cerebral arterial hypo-perfusion. Seven patients underwent stenting of the IJV stenosis correction, their WMHs attenuated or disappeared subsequently.
CONCLUSIONS
Imaging features in addition to clinical symptoms can be used to differentiate between physiologic IJV slenderness and pathologic IJV stenosis. Notable imagine-defining features for IJV stenosis include local stenosis surrounded by abnormal venous collaterals, cloudy-like WMHs, and mismatch between the transverse diameter of IJV and the caliber of the jugular foramina.
Topics: Case-Control Studies; Constriction, Pathologic; Humans; Jugular Veins; Magnetic Resonance Imaging; Neck
PubMed: 35919952
DOI: 10.1111/cns.13924 -
Surgical and Radiologic Anatomy : SRA May 2023Anatomical knowledge of the hypoglossal canal is very important in relation to drilling of occipital condyle, jugular tubercle etc. So, this study was conducted to...
PURPOSE
Anatomical knowledge of the hypoglossal canal is very important in relation to drilling of occipital condyle, jugular tubercle etc. So, this study was conducted to identify various morphometric and morphological features of the hypoglossal canal and its distance from adjacent structures relative to stable and reliable anatomic landmarks.
METHODS
The study was performed on 142 hypoglossal canals of 71 adult human dry skulls. The parameters measured were the transverse, vertical diameter, depth of the hypoglossal canal. The distances from the hypoglossal canal to the foramen magnum, occipital condyle and jugular foramen were also noted. In addition, the different locations of the hypoglossal canal orifices in relation to the occipital condyle were assessed. The different shapes and types of the hypoglossal canal were also noted.
RESULTS
There was significant difference (p < 0.05) in measurements taken on the right and left sides in males and females. The intracranial orifice of hypoglossal canal was present in middle 1/3rd in 100% of occipital condyle for both genders. The extracranial orifice of the hypoglossal canal was found to be in the anterior 1/3rd in 99% and 93.7% for male and female, respectively. Simple hypoglossal canal with no traces of partition was found to be more in males and females. The most common shape noted was oval both in males and females (71.8% and 68.7% respectively).
CONCLUSION
The results of the dimensions of the hypoglossal canal and its distance from other bony landmarks will be helpful for neurosurgeons to plan which surgical approaches should be undertaken while doing various surgeries in posterior cranial fossa.
Topics: Adult; Female; Male; Humans; Occipital Bone; Foramen Magnum; Skull; Neurosurgical Procedures; Cranial Fossa, Posterior; Orthopedic Procedures; Skull Base
PubMed: 36930271
DOI: 10.1007/s00276-023-03126-7 -
World Neurosurgery May 2022Inflammatory pseudotumor (IP) is a nonneoplastic, reactive inflammatory process, of unknown etiology, characterized by a proliferation of connective tissue with an... (Review)
Review
Inflammatory pseudotumor (IP) is a nonneoplastic, reactive inflammatory process, of unknown etiology, characterized by a proliferation of connective tissue with an inflammatory infiltrate, most commonly involving the lungs and orbits. Primary intracranial IP is an extremely rare entity often arising from the meningeal structures of the skull base. We reported an extremely rare case of a primary intracranial IP located in the cerebellopontine angle, mimicking a jugular foramen meningioma. We further illustrated our microsurgical technique through a surgical video and performed a review of the pertinent scientific literature. The patient underwent gross total microsurgical resection of the tumor mass through a left retrosigmoid approach. Intraoperative neuromonitoring of the VII-VIII cranial nerve complex and lower cranial nerve was performed, and thulium laser fibers were used as a tool for tumor debulking. Postoperatively, the patient's neurologic symptoms recovered. Histopathologic studies showed dense infiltrate of T- and B-cell lymphocytes and epithelioid granulomas, compatible with the diagnosis of IP. Postoperatively, magnetic resonance imaging scans showed complete tumor resection. The patient underwent a 3-month oral corticosteroid therapy showing no signs of recurrence at the radiologic follow-up. Primary intracranial IPs are rare pathologic entities that can mimic extraaxial tumors and should be taken into consideration as a potential differential diagnosis. Complete microsurgical resection in combination with other treatments (steroids therapy, radiotherapy) is the most common treatment of choice and is associated with good outcomes and low rates of recurrence.
Topics: Granuloma, Plasma Cell; Humans; Jugular Foramina; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Skull Base Neoplasms
PubMed: 35092811
DOI: 10.1016/j.wneu.2022.01.069 -
Operative Neurosurgery (Hagerstown, Md.) Sep 2023The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and...
BACKGROUND AND OBJECTIVES
The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and lateral exposure than the extreme lateral and endoscopic endonasal approach, respectively. We describe the microsurgical anatomy of ALA with cadaveric specimens and report our clinical experience for benign JF tumors with predominant extracranial extension.
METHODS
A stepwise and detailed microsurgical neurovascular anatomy of ALA was explored with cadaveric specimens. Then, the clinical results of 7 consecutive patients who underwent ALA for benign JF tumors with predominant extracranial extension were analyzed.
RESULTS
A hockey stick skin incision is made along the superior nuchal line to the anterior edge of the sternocleidomastoid muscle (SCM). ALA involves layer-by-layer muscle dissection of SCM, splenius capitis, digastric, longissimus capitis, and superior oblique muscles. The accessory nerve runs beneath SCM and is found at the posterior edge of the digastric muscle. The internal jugular vein (IJV) is lateral to and at the level of the accessory nerve. The occipital artery passes over the longissimus capitis muscle and IJV and into the external carotid artery, which is lateral and superficial to IJV. The internal carotid artery (ICA) is more medial and deeper than external carotid artery and is in the carotid sheath with the vagus nerve and IJV. The hypoglossal and vagus nerves run along the lateral and medial side of ICA, respectively. Prehigh cervical carotid, prejugular, and retrojugular surgical corridors allow deep and extracranial access around JF. In the case series, gross and near-total resections were achieved in 6 (85.7%) patients without newly developed cranial nerve deficits.
CONCLUSION
ALA is a traditional and invaluable neurosurgical approach for benign JF tumors with predominant extracranial extension. The anatomic knowledge of ALA increases competency in adding anterior and lateral exposure of extracranial JF.
Topics: Humans; Jugular Foramina; Cranial Fossa, Posterior; Accessory Nerve; Head and Neck Neoplasms; Cadaver
PubMed: 37195061
DOI: 10.1227/ons.0000000000000763 -
Three-Corridors Procedure to Operate in the Infralabyrinthine Cervico-Jugulo-Carotico-Tympanic Area.ORL; Journal For Oto-rhino-laryngology... 2022The aim of the study was to present the results of our experience in three-corridors procedures applied for the tumors and inflammatory lesions of the infralabyrinthine...
INTRODUCTION
The aim of the study was to present the results of our experience in three-corridors procedures applied for the tumors and inflammatory lesions of the infralabyrinthine cervico-jugulo-carotico-tympanic area.
METHODS
The lesions located in the infralabyrinthine cervico-jugulo-carotico-tympanic area were operated in 13 patients using the 3-corridors technique. The anatomical and functional integrity of the external and middle ears and the facial nerve (FN) could be preserved.
RESULTS
The diagnoses were glomus jugulare, infralabyrinthine petrous bone cholesteatoma, jugular foramen schwannoma, and giant-cell tumor. The follow-up duration ranged from 2 to 24 months. No tumor recurrence or growth was encountered in the follow-up. The operations were uneventful. Total surgical excision could be achieved in 10 patients. A second-stage retrosigmoid approach was performed for the total removal of the intracranial tumor remnant in two patients. A wait-and-scan policy has been considered in one patient who had partial resection for a glomus jugulare tumor.
CONCLUSION
Three-corridors procedure seems to be a useful technique to operate in the infralabyrinthine, cervico-jugulo-carotico-tympanic area as it takes the advantage of hearing preservation, preservation of the anatomic and functional integrity of the external and middle ear structures as well as the FN.
Topics: Ear, Middle; Facial Nerve; Glomus Jugulare Tumor; Humans; Neoplasm Recurrence, Local; Petrous Bone; Retrospective Studies
PubMed: 35114674
DOI: 10.1159/000521441 -
Acta Neurochirurgica Feb 2022Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires...
Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part III: Lower cranial nerve schwannomas, jugular foramen (CN IX, X, XI) and hypoglossal schwannoma (XII).
BACKGROUND
Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear, and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations.
METHODS
A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the third of a three-part series describing non-vestibular schwannomas (IX, X, XI, XII).
RESULTS
A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to preoperative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies and follow-up management.
CONCLUSION
This article represents the consensually derived opinion of the task force with respect to the treatment of non-vestibular schwannomas. For each of these tumours, the management paradigm is shifting towards the compromise between function preservation and progression free survival.
Topics: Adult; Cranial Nerve Neoplasms; Cranial Nerves; Humans; Jugular Foramina; Neurilemmoma; Skull Base
PubMed: 34854994
DOI: 10.1007/s00701-021-05072-y -
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