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Journal of Neurological Surgery. Part... Feb 2021Surgical removal of large jugular foramen schwannomas with intra- and extracranial extension is challenging. The treatment goal is a gross total resection of the tumor...
Surgical removal of large jugular foramen schwannomas with intra- and extracranial extension is challenging. The treatment goal is a gross total resection of the tumor without causing surgical complications, including facial nerve paresis, hearing disturbance, dysphagia, hoarseness, and cerebrospinal fluid (CSF) leakage, in addition to the brain stem injury. We present a surgical video in a patient with a dumbbell-shaped glossopharyngeal schwannoma. The combination of posterior fossa craniotomy, mastoidectomy, and unroofing of the jugular foramen with high cervical exposure was selected. Although transposition of the mastoid segment of the facial nerve provides an excellent surgical corridor, it may affect normal facial nerve function. Sufficient drilling of the infralabyrinthine, retrofacial area of the mastoid without facial nerve transposition is important for the safe gross total removal of the tumor. Subcapsular removal behind the jugular vein is also important for preservation of the lower cranial nerve functions. The patient underwent a gross total removal of the tumor ( Figs. 1 and 2 ). Facial nerve function was preserved and hearing disturbance improved. Although dysphagia and hoarseness complicated postoperatively, he became able to take foods orally 16 days after the surgery. In summary, successful removal of a large dumbbell-shaped jugular foramen tumor can be completed via infralabyrinthine, retrofacial, and transjugular approach without facial nerve transposition. The link to the video can be found at: https://youtu.be/U4CwOW78id4 .
PubMed: 33717822
DOI: 10.1055/s-0040-1705167 -
Cureus Feb 2023Jugular foramen tumours are uncommon, deeply located, and eloquently situated, making their diagnosis and management challenging. Paragangliomas and other benign tumours...
Jugular foramen tumours are uncommon, deeply located, and eloquently situated, making their diagnosis and management challenging. Paragangliomas and other benign tumours comprise the large majority of lesions in this region, but malignant tumours are occasionally identified. We report a unique case of a solitary plasmacytoma of the jugular foramen resembling a jugulotympanic paraganglioma. A solitary plasmacytoma of the jugular foramen is both rare in location and in disease presentation, as most plasma cell neoplasms are diagnosed as multiple myeloma. Our 75-year-old patient presented with symptoms typical for a jugular foramen tumour. Although there are radiographic features which help differentiate paragangliomas from other benign and malignant tumours, plasmacytomas are highly vascular and can demonstrate a local infiltrative spread which can mimic the radiographic appearance of a paraganglioma. Clinicians should consider plasma cell neoplasms in the differential when faced with an unusual presentation of a jugular foramen lesion. Our patient was treated with definitive radiotherapy to 45 Gy, which was very effective local treatment for the solitary plasmacytoma.
PubMed: 37007391
DOI: 10.7759/cureus.35592 -
Cureus Nov 2021Introduction Lesions of the jugular foramen (JF) and postero-lateral skull base are difficult to expose and exhibit complex neurovascular relationships. Given their...
Introduction Lesions of the jugular foramen (JF) and postero-lateral skull base are difficult to expose and exhibit complex neurovascular relationships. Given their rarity and the increasing use of radiosurgery, neurosurgeons are becoming less experienced with their surgical management. Anatomical factors are crucial in designing the approach to achieve a maximal safe resection. Methods and methods Six cadaveric heads (12 sides) were dissected via combined post-auricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. Contiguous surgical triangles were measured, and contents were analyzed. Thirty-one patients (32 lesions) were treated surgically between 2000 and 2016 through different variations of the retro-auricular distal cervical transtemporal approaches. Results We anatomically reviewed the carotid, stylodigastric, jugular, condylar, suboccipital, deep condylar, mastoid, suprajugular, suprahypoglossal (infrajugular), and infrahypoglossal triangles. Tumors included glomus jugulare, lower cranial nerve schwannomas or neurofibromas, meningiomas, chondrosarcoma, adenocystic carcinoma, plasmacytoma of the occipitocervical joint, and a sarcoid lesion. We classified tumors into extracranial, intradural, intraosseous, and dumbbell-shaped, and analyzed the approach selection for each. Conclusion Jugular foramen and posterolateral skull base lesions can be safely resected through a retro-auricular distal cervical lateral skull base approach, which is customizable to anatomical location and tumor extension by tailoring the involved osteo-muscular triangles.
PubMed: 34956763
DOI: 10.7759/cureus.19638 -
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 -
La Clinica Terapeutica 2023The present study aimed at determining the incidence of sternal foramina in adult dry bones of North Indian descent. We also aimed to determine the number, precise... (Observational Study)
Observational Study
OBJECTIVES
The present study aimed at determining the incidence of sternal foramina in adult dry bones of North Indian descent. We also aimed to determine the number, precise location of the sternal foramina with a standard reference point which might have considerable importance with regard to procedures involving sternal puncture.
METHODS
This cross sectional descriptive study was conducted on 72 dry adult human sternums. Various measurements in relation to the sternal foramina were taken with a non-stretchable measuring tape and digital vernier calliper and expressed as: [A]-total sternal length, [B]-distance between the jugular notches to the foramen, [C]-distance between the angle of Louis to the foramen and [D]-distance of the foramen from the mid sternal plane. Statistical analysis was performed with Microsoft Excel version 2019. A p-value of <0.05 was considered significant.
RESULTS
We found 6.94% (5 out of 72 sternums) incidence of sternal foramina which corroborates well with the existing literature. Mean sternal length was 127.7 ± 09 mm. The mean distance of the foramina from suprasternal notch, sternal angle and from the median plane were 118.12 ± 0.3 mm, 116.7 mm and 2.4 mm respectively. Incidence of sternal foramina was almost similar to previously reported studies.
CONCLUSIONS
The precise knowledge about the expected location of sternal foramina is imperative to avoid intra-thoracic visceral injury during commonly performed acupuncture needle insertion and while doing bone marrow aspiration for diagnostic evaluation.
Topics: Adult; Humans; Clinical Relevance; Cross-Sectional Studies; Knowledge; Neck; Research Design
PubMed: 38048113
DOI: 10.7417/CT.2023.5017 -
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 -
Journal of Neurological Surgery. Part... Jun 2022The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal...
The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.
PubMed: 35832999
DOI: 10.1055/s-0041-1731034 -
Anatomy & Cell Biology Mar 2023Anatomical knowledge of the occipital condyle (OC) and its relationships to surrounding structures is important for avoiding injury during craniovertebral junction (CVJ)...
Morphological analysis and morphometry of the occipital condyle and its relationship to the foramen magnum, jugular foramen, and hypoglossal canal: implications for craniovertebral junction surgery.
Anatomical knowledge of the occipital condyle (OC) and its relationships to surrounding structures is important for avoiding injury during craniovertebral junction (CVJ) surgeries. This study was conducted to evaluate the morphology and morphometry of OC and its relationship to foramen magnum, jugular foramen (JF), and hypoglossal canal (HC). Morphometric parameters including length, width, height, and distances from the OC to surrounding structures were measured. The oval-like condyle was the most common OC shape, representing for 33.0% of all samples. The mean length, width and height of OC were 21.3±2.4, 10.5±1.4, and 7.4±1.1 mm, respectively. Moreover, OC was classified into three types based on its length. The most common OC length in both sexes was moderate length or type II (62.5%). The mean distance between anterior tips and posterior tips of OC to basion, and opisthion were 11.5±1.4, 39.1±3.3, 25.2±2.2, and 27.4±2.7 mm, respectively. The location of intracranial orifice of HC was commonly found related to middle 1/3 of OC in 45.0%. JF was related to the anterior 2/3 of OC in 81.0%, the anterior 1/3 of OC in 12.5%, and the entire OC length in 6.5%. These morphological analysis and morphometric data should be taken into consideration before performing surgical operation to avoid CVJ instability and neurovascular structure injury.
PubMed: 36635090
DOI: 10.5115/acb.22.105 -
Journal of Neurological Surgery. Part... Feb 2022To prevent damage to the facial nerve while doing surgery and to give facial nerve block by anesthetics near the stylomastoid foramen we should know its distance...
To prevent damage to the facial nerve while doing surgery and to give facial nerve block by anesthetics near the stylomastoid foramen we should know its distance from the important anatomical landmarks. So, this study aims to study the location of stylomastoid with respect to nearby anatomical landmarks. The study was performed on 58 dry skulls. Measurements of stylomastoid foramen were taken from various anatomical landmarks on both sides of the skull. Data analysis was done by using the Statistical Package for Social Sciences (SPSS) 19 version. The mean distance of the center of the stylomastoid foramen (CSMF) to the tip of the mastoid process was 1.60, 1.57 cm on the right and left side, respectively. The mean distance of CSMF to the upper end of the anterior border of the mastoid process was 1.42, 1.39 cm on the right and left side, respectively. The mean angle between CSMF and tip of the mastoid process was 51.6 degrees, 53.5 degrees on right and left side, respectively. The mean distance of CSMF to the center of jugular foramen was 1.27, 1.26 cm on the right and left side, respectively. The position of the stylomastoid foramen in relation to a transverse line passing through the upper end of the anterior border of both mastoid processes was anterior in 82.7%, 94.8% of cases on the right and left side, respectively. These measurements will aid neurosurgeons in doing surgeries near the stylomastoid foramen or anesthetics to give facial nerve block near the foramen.
PubMed: 35155067
DOI: 10.1055/s-0040-1716674 -
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