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The Neurohospitalist Jul 2023Jugular foramen syndrome (JFS) is a lower cranial neuropathy syndrome characterized by dysphonia and dysphagia. The syndrome is caused by dysfunction of the...
Jugular foramen syndrome (JFS) is a lower cranial neuropathy syndrome characterized by dysphonia and dysphagia. The syndrome is caused by dysfunction of the glossopharyngeal, vagus, and spinal accessory nerves at the level of the pars nervosa and pars vascularis within the jugular foramen. There are numerous etiologies for JFS, including malignancy, trauma, vascular, and infection. Here, we present the case of a healthy adult man who developed JFS secondary to an atypical presentation of Varicella Zoster meningitis, and was promptly diagnosed and treated with rapid symptom resolution. We diagnosed the patient using specialized skull-based imaging which detailed the jugular foramen, as well as CSF analysis. This case highlights the clinical value of detailed structural evaluation, consideration for infection in the absence of systemic symptoms, and favorable outcomes following early identification and treatment.
PubMed: 37441204
DOI: 10.1177/19418744221116717 -
Operative Neurosurgery (Hagerstown, Md.) Mar 2024Endoscopic endonasal far-medial approach provides an effective and safe corridor to access the parasagittal structures of the lower clivus such as the medial jugular...
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE
Endoscopic endonasal far-medial approach provides an effective and safe corridor to access the parasagittal structures of the lower clivus such as the medial jugular tubercle (JT) and occipital condyle (OC) for lesions that displace neurovascular structures laterally.
ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT
Parapharyngeal internal carotid arteries (ICAs) run posterolateral to the eustachian tubes and lateral to the OC. The supracondylar groove is a superficial landmark for the hypoglossal canal, which divides the lateral extension of clivus into the JT and OC.
ESSENTIAL STEPS OF THE PROCEDURE
Typically, approach starts with opening of the sphenoid sinus to localize the paraclival ICA. An "inverted U" rhinopharyngeal (RP) flap exposing the supracondylar groove and lower clivus. Doppler and navigation can confirm the course of the ICA. Drilling is started in the midline in the lower clivus and extended laterally to expose the hypoglossal canal, JT, and OC.
PITFALLS/AVOIDANCE OF COMPLICATIONS
Neurovascular injuries can be avoided by using intraoperative Doppler and nerve stimulator. Multilayer reconstruction with vascularized nasoseptal (NSF) and RP flaps minimize postoperative cerebrospinal fluid leak.
VARIANTS AND INDICATIONS FOR THEIR USE
The contralateral transmaxillary approach provides an increased angle of access behind foramen lacerum and the petrous ICA.The endoscopic endonasal far-medial approach can be used for a variety of pathologies, including petroclival or JT meningiomas, chordomas and chondrosarcomas, and hypoglossal schwannomas, inferiorly extending cholesterol granulomas and even rare, ventral posterior inferior cerebellar artery aneurysms.The patients consented to the procedure.
Topics: Humans; Skull Base; Cadaver; Nose; Endoscopy; Cranial Fossa, Posterior
PubMed: 37917886
DOI: 10.1227/ons.0000000000000970 -
World Neurosurgery May 2022The intermediate condylar canal, which lies lateral to the occipital condyles and medial to the jugular foramen, is rarely mentioned in textbooks, even those devoted to...
BACKGROUND
The intermediate condylar canal, which lies lateral to the occipital condyles and medial to the jugular foramen, is rarely mentioned in textbooks, even those devoted to the skull base. Therefore the present anatomic study was performed to better elucidate these structures.
METHODS
We studied 100 adult skulls (200 sides) to better understand the prevalence and anatomy of the intermediate condylar canal.
RESULTS
An intermediate canal was found on 6 of 200 sides (3%). On average, these canals traveled 7.1 mm lateral to the occipital condyle and had a mean of 2.2 mm posteromedial to the jugular foramen. Anteriorly, these canals opened into the external surface of the hypoglossal canal and, when present, were just medial to a paracondylar process for which there was a strong positive correlation. The length of the canals ranged from 5 to 7.8 mm. In all, there were 3 partial canals and 3 complete canals. One left canal communicated anteriorly at the confluence of the inferior opening of a septated (bifurcated) hypoglossal canal and an unnamed foramen medial to the jugular foramen. These canals were distinct from posterior condylar canals when the latter was present.
CONCLUSIONS
Knowledge of the anatomic variants at the base of the skull may help minimize complications during surgical procedures that employ a paracondylar or transcondylar approach or approaches to the jugular foramen.
Topics: Adult; Cadaver; Humans; Neurosurgical Procedures; Occipital Bone; Orthopedic Procedures; Skull; Skull Base
PubMed: 35033691
DOI: 10.1016/j.wneu.2022.01.028 -
Operative Neurosurgery (Hagerstown, Md.) Nov 2022Large, destructive intracranial and extracranial lesions at the jugular foramen (JF) and anterior craniovertebral junction (CVJ) are among the most challenging lesions...
Quantitative Anatomic Comparison of the Extreme Lateral Transodontoid vs Extreme Medial Endoscopic Endonasal Approaches to the Jugular Foramen and Craniovertebral Junction.
BACKGROUND
Large, destructive intracranial and extracranial lesions at the jugular foramen (JF) and anterior craniovertebral junction (CVJ) are among the most challenging lesions to resect.
OBJECTIVE
To compare the extreme lateral transodontoid approach (ELTOA) with the extreme medial endoscopic endonasal approach (EMEEA) to determine the most effective surgical approach to the JF and CVJ.
METHODS
Seven formalin-fixed cadaveric heads were dissected. Using neuronavigation, we quantitatively measured and compared the exposure of the intracranial and extracranial neurovascular structures, the drilled area of the clivus and the C1 vertebra, and the area of exposure of the brainstem.
RESULTS
The mean total drilled area of the clivus was greater with the EMEEA than with the ELTOA (1043.5 vs 909.4 mm 2 , P = .02). The EMEEA provided a longer exposure of the extracranial cranial nerves (CNs) IX, X, and XI compared with the ELTOA (cranial nerve [CN] IX: 18.8 vs 12.0 mm, P = .01; CN X: 19.2 vs 10.4 mm, P = .003; and CN XI, 18.1 vs 11.9 mm, P = .04). The EMEEA, compared with the ELTOA, provided a significantly greater area of exposure of the contralateral ventromedial medulla (289.5 vs 80.9 mm 2 , P < .001) and pons (237.5 vs 86.2 mm 2 , P = .005) but less area of exposure of the ipsilateral dorsolateral medulla (51.5 vs 205.8 mm 2 , P = .008).
CONCLUSION
The EMEEA and ELTOA provide optimal exposures to different aspects of the CVJ and JF. A combination of these approaches can compensate for their disadvantages and achieve significant exposure.
Topics: Cranial Fossa, Posterior; Endoscopy; Formaldehyde; Humans; Jugular Foramina; Nose
PubMed: 36103356
DOI: 10.1227/ons.0000000000000350 -
AJNR. American Journal of Neuroradiology Oct 2021Accurate differentiation of paragangliomas and schwannomas in the jugular foramen has important clinical implications because treatment strategies may vary but...
BACKGROUND AND PURPOSE
Accurate differentiation of paragangliomas and schwannomas in the jugular foramen has important clinical implications because treatment strategies may vary but differentiation is not always straightforward with conventional imaging. Our aim was to evaluate the accuracy of both qualitative and quantitative metrics derived from dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel MR imaging to differentiate paragangliomas and schwannomas in the jugular foramen.
MATERIALS AND METHODS
A retrospective study of imaging data was performed on patients ( = 30) undergoing MR imaging for jugular foramen masses with the golden-angle radial sparse parallel MR imaging technique. Imaging data were postprocessed to obtain time-intensity curves and quantitative parameters. Data were normalized to the dural venous sinus for relevant parameters and analyzed for statistical significance using a Student test. A univariate logistic model was created with a binary output, paraganglioma or schwannoma, using a wash-in rate as a variable. Additionally, lesions were clustered on the basis of the wash-in rate and washout rate using a 3-nearest neighbors method.
RESULTS
There were 22 paragangliomas and 8 schwannomas. All paragangliomas demonstrated a type 3 time-intensity curve, and all schwannomas demonstrated a type 1 time-intensity curve. There was a statistically significant difference between paragangliomas and schwannomas when comparing their values for area under the curve, peak enhancement, wash-in rate, and washout rate. A univariate logistic model with a binary output (paraganglioma or schwannoma) using wash-in rate as a variable was able to correctly predict all observed lesions ( < .001). All 30 lesions were classified correctly by using a 3-nearest neighbors method.
CONCLUSIONS
Paragangliomas at the jugular foramen can be reliably differentiated from schwannomas using golden-angle radial sparse parallel MR imaging-dynamic contrast-enhanced imaging when imaging characteristics cannot suffice.
Topics: Contrast Media; Humans; Jugular Foramina; Magnetic Resonance Imaging; Neurilemmoma; Paraganglioma; Retrospective Studies
PubMed: 34503944
DOI: 10.3174/ajnr.A7243 -
Neurocirugia (English Edition) 2020Schwannomas of the glossopharyngeal nerve are extremely rare tumors of the posterior fossa. In a 100-year review, a total of 42 cases were found between 1908-2008. The...
Schwannomas of the glossopharyngeal nerve are extremely rare tumors of the posterior fossa. In a 100-year review, a total of 42 cases were found between 1908-2008. The most common clinical data are associated with its location, the most common being cochlear vestibule symptoms and symptoms of glossopharyngeal nerve function. its diagnosis has now been facilitated by the use of magnetic resonance, however, it is very complicated to define preoperatively if the tumor originates from the ix, x or xi NC. We present the case of a 42-year-old patient with a syndrome of angulopentocerebellar syndrome, posterior torn (jugular) hole syndrome + anterior condyle (Collet-Sicard). The treatment used was surgical with transcondylar lateral extreme approach, with monitoring of cranial nerves and trans-operative evoked potentials.
Topics: Adult; Glossopharyngeal Nerve; Humans; Neurilemmoma; Syndrome
PubMed: 31213391
DOI: 10.1016/j.neucir.2019.05.003 -
Radiographics : a Review Publication of... 2020Temporal bone trauma is frequently encountered in the emergency department. Technologic advances have enabled timely acquisition of thin-section images and multiplanar... (Review)
Review
Temporal bone trauma is frequently encountered in the emergency department. Technologic advances have enabled timely acquisition of thin-section images and multiplanar reconstructions such that temporal bone anatomy can be evaluated in great detail, with excellent delineation of fractures. The temporal bone is composed of a myriad of tiny structures, including many fissures and canals, that must be distinguished from true fractures. In addition, injury to important structures may result in serious complications such as hearing loss, dizziness, imbalance, perilymphatic fistula, cerebrospinal fluid leakage, facial nerve paralysis, and vascular injury. Structures that should be examined include the tympanic cavity and tegmen, the ossicular chain, the bony labyrinth, the facial canal, the internal carotid artery, the jugular foramen and venous sinuses, and the intracranial contents. Radiologists should be familiar with the anatomy of the temporal bone and be able to describe any pathologic findings and make suggestions to referring clinicians to guide management and determine the prognosis. The authors describe the typical CT and MRI appearances of temporal bone trauma, entities that mimic this injury and thus must be differentiated, and compulsory points for evaluating clinically relevant associated complications. Instruction is provided for acquiring the diagnostic skills necessary to report suggested injury status, complications, and likely sequelae to clinicians.RSNA, 2020.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Skull Fractures; Temporal Bone; Tomography, X-Ray Computed
PubMed: 32442046
DOI: 10.1148/rg.2020190023 -
Cancers Mar 2021Stereotactic radiosurgery (SRS) is known to provide excellent tumor control with functional preservation for vestibular schwannomas (VS), but its efficacy in the other...
Stereotactic radiosurgery (SRS) is known to provide excellent tumor control with functional preservation for vestibular schwannomas (VS), but its efficacy in the other major intracranial schwannomas including trigeminal (TS), facial (FS), and jugular foramen schwannomas (JFS) has not been established yet due to their rarity. We retrospectively analyzed data of 514 consecutive patients who had intracranial schwannomas (460 VS, 22 TS, 7 FS, and 25 JFS) and underwent SRS. The 5- and 10-year tumor control rates were 97% and 94% for VS, 100% and 100% for TS, 80% and 80% for FS, and 100% and 80% for JFS. Radiation-induced complications included one hydrocephalus for TS (4.5%), no cases for FS (0%), and one hydrocephalus and one lower palsy for JFS (8.0%). Through matched cohort analysis between patients with VS and each of the non-VS, we found no statistical difference in tumor control and radiation-induced adverse events. SRS seems to provide long-term tumor control with functional preservation for TS, FS and JFS and the efficacies are similar to VS.
PubMed: 33799972
DOI: 10.3390/cancers13051140 -
Child's Nervous System : ChNS :... Jun 2022To identify MRI-based quantitative craniofacial variables linked to airways narrowing and obstructive sleep apnea (OSA) development in children with achondroplasia.
PURPOSE
To identify MRI-based quantitative craniofacial variables linked to airways narrowing and obstructive sleep apnea (OSA) development in children with achondroplasia.
METHODS
We evaluated skull base and midface MRI in two cohorts of children affected by achondroplasia, with (group 1) or without OSA (group 2). 3DFSPGR-T1weighted images were used to assess airways volume (nasopharynx, oropharynx, and laryngopharynx), jugular foramina (JF) and hypoglossal foramina (HF) areas, foramen magnum area, cervical cord area, and maxillary retrusion (SNA angle).
RESULTS
Nineteen out of 27 children with achondroplasia exhibited different degrees of obstructive respiratory impairment (n.4 mild, n.8 moderate, n.7 severe), while 8 children did not show OSA. Each group was compared with age-matched controls without neuroimaging abnormalities. Both groups showed reduced nasopharynx volume, JF areas, and SNA angle, while group 1 showed also reduced oropharynx volume, ratio of FM/cervical cord areas, and HF areas (p < 0.05). A positive correlation between nasopharynx volume and SNA angle was found in both groups, while a positive correlation among upper airways volume, JF and HF areas was found only in group 1. No correlation between upper airways volume and OSA severity was found.
CONCLUSION
In children with achondroplasia, multifaced craniofacial abnormalities contribute to airways volume reduction predisposing to sleep disordered breathing. MRI-based quantitative assessment allows the appraisal of craniofacial variables linked to the development of sleep-disordered breathing such as FM stenosis, jugular and hypoglossal foramina stenosis, and retruded maxillary position and may be a valuable tool for clinical surveillance.
Topics: Achondroplasia; Child; Constriction, Pathologic; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 35277732
DOI: 10.1007/s00381-022-05484-w -
Vestnik Otorinolaringologii 2023In this article we present the surgical approaches to the temporal bone paraganglioma based on the anatomical studies.
UNLABELLED
In this article we present the surgical approaches to the temporal bone paraganglioma based on the anatomical studies.
OBJECTIVE
To detalize the anatomy of the jugular foramen according to the comparison of cadaver dissections findings and the CT scans data that were performed before the dissections, for improvement of quality of treatment of patients with temporal bone paraganglioma (Fisch type C).
MATERIAL AND METHODS
The data of CT scans and the steps of the approaches to the jugular foramen (retrofacial and infratemporal approaches with opening of jugular bulb and identification of the anatomical structures of jugular foramen) were analyzed on 10 cadaver heads, 20 sides. Clinical implementation was demonstrated in case of temporal bone paraganglioma type C.
RESULTS
Based on the detail study of the CTs data we revealed the individual features of the temporal bone structures. Due to the results of 3D rendering the average length of the jugular foramen in anterior-posterior direction was 10.1 mm. The length of vascular part was larger than the nervous part. The posterior part had the bigger height wherein the shortest part we detected between jugular ridges, which in some cases caused the dumbbell shape of jugular foramen. According to 3D multiplanar reconstruction the distances between jugular crests (3.0 mm) had the lowest measures and the largest was between internal auditory canal (IAC) and jugular bulb (JB) (8.01mm). At the same time, one of the largest variations of values was also identified between IAC and JB (from 4.39 to 9.84 mm). The distance between the facial nerve in the mastoid segment and JB was variable (from 3.4 to 10.2 mm) and determined by the volume and position of the JB. The results of the dissection corresponded to the measurements according to the CT scans, taking into account the 2-3 mm error due to the massive removal of temporal bone during performing of surgical approaches.
CONCLUSION
The detailed knowledge of the surgical anatomy of the jugular foramen based on a thorough analysis of preoperative CT data is the key to an adequate surgical tactic for the removal of different types of temporal bone paraganglioma while preserving the function of vital structures and the quality of life. A larger study on the big data is needed to determine the statistical relationship between the volume of JB and the size of the jugular crest; the correlation between the dimensions of jugular crests and the tumor invasion in the anterior part of the jugular foramen.
Topics: Humans; Jugular Foramina; Quality of Life; Paraganglioma; Temporal Bone; Cadaver
PubMed: 36867138
DOI: 10.17116/otorino20228801110