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The Journal of Craniofacial SurgeryCraniomaxillofacial trauma is usually accompanied by indwelling foreign bodies, and some of those are close to the carotid artery, which increases the risks and...
PURPOSE
Craniomaxillofacial trauma is usually accompanied by indwelling foreign bodies, and some of those are close to the carotid artery, which increases the risks and difficulties of surgical treatment. The introduction of interventional radiology combined with image-guided surgical navigation may be a good solution for precise surgery to remove foreign bodies.
PATIENTS AND METHODS
Four patients were included in the study. All patients underwent digital subtraction angiography and enhanced computed tomography before surgery. The patients were divided into 3 categories (A, B, and C) according to the presence of carotid artery damage and its positional relationship with the foreign body, and 3 corresponding treatment strategies were developed. Treatments were completed using interventional radiology and surgical navigation systems.
RESULTS
All foreign bodies were completely removed, except for 1 remaining in the jugular foramen in a patient. The prognosis of all patients was good, and no systemic complications occurred.
CONCLUSION
The combined interventional radiology and surgical navigation method proposed in this study is an effective method to improve the accuracy and safety of foreign body removal surgery.
Topics: Humans; Foreign Bodies; Tomography, X-Ray Computed; Surgery, Computer-Assisted; Carotid Artery, Common
PubMed: 36138542
DOI: 10.1097/SCS.0000000000008858 -
Neurosurgical Focus: Video Oct 2019Surgery of glomus jugulare tumors is complex, but when these tumors have a large intradural component and cause brainstem compression they became a challenge to the...
Surgery of glomus jugulare tumors is complex, but when these tumors have a large intradural component and cause brainstem compression they became a challenge to the surgeon. It is crucial to preoperatively understand the anatomy of the tumor and analyze its relationship with the temporal bone, facial nerve, and foramen jugular neurovascular structures. We present a case of a male patient with a complex glomus jugulare tumor causing severe brainstem compression. Nuances of technique and surgical pearls related to the management of complex jugulare tumors are discussed and illustrated in this operative video. The video can be found here: https://youtu.be/oCjzp0kFRGc.
PubMed: 36284862
DOI: 10.3171/2019.10.FocusVid.19461 -
Surgical Neurology International 2023The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death....
BACKGROUND
The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death. Modern surgical interventions may still result in a wide range of complications and cerebral venous thrombosis (CVT) is among them.
CASE DESCRIPTION
A 38-year-old female with an existing diagnosis of diabetes mellitus (DM) and hypothyroidism and a 6-month history of headaches, blurred vision, and vomiting presented to our clinic 3 days after the headaches became excessively severe. Neurological examination on admission revealed bilateral papilledema without any associated focal neurological deficits. Brain computed tomography and magnetic resonance imaging confirmed the presence of a third ventricle CC and associated non-communicating hydrocephalus involving the lateral ventricles. As a result, the patient underwent emergency bilateral external ventricular drainage (EVD) insertion followed by a third ventricular CC excision under neuronavigation through a right frontal craniotomy. Twelve days postoperatively, the patient developed further headaches followed by a generalized tonic-clonic seizure that led to no postictal neurological deficits. Nonetheless, computed tomography venography of the brain revealed extensive thrombosis of the superior sagittal sinus, inferior sagittal sinus, right sigmoid sinus, and right internal jugular vein. A newly diagnosed CVT was treated with intravenous heparin. The patient was discharged with warfarin, which was discontinued after 12 months. Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from chronic mild headaches.
CONCLUSION
A preoperative venous study should be performed in all cases to gain a better understanding of the venous anatomy. We advocate meticulous microsurgical techniques to protect the venous system surrounding the foramen of Monro and reduce the amount of retraction during surgery.
PubMed: 37404486
DOI: 10.25259/SNI_348_2023 -
Journal of Neurological Surgery. Part... Feb 2024To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine...
To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine lesions. Five dry skulls were examined for surgical approach. Three adult cadaveric heads underwent bilateral dissection. One cadaveric head was evaluated with computed tomography after dissection. This study was performed in an academic medical center. Neurosurgical anatomy researchers performed this study using dry skulls and cadaveric heads. This was a proof-of-concept anatomical study. The mandibular fossa approach uses a vertical preauricular incision above the facial nerve branches. Removal of the temporomandibular joint exposes the mandibular fossa. The anterior boundary is the mandibular nerve at the foramen ovale, and the posterior boundary is the jugular foramen. The chorda tympani, eustachian tube, and tensor tympani muscle are sectioned. The carotid artery is transposed out of the petrous canal, and a petrosectomy is performed from Meckel's cave to the foramen magnum and anterior occipital condyle. Dural opening exposes the anterior pons, vertebrobasilar junction, bilateral vertebral arteries, and the ipsilateral anterior and posterior inferior cerebellar arteries. At completion, the temporomandibular joint is reconstructed with a prosthetic joint utilizing a second incision along the mandible. The mandibular fossa approach is a new trajectory to the petroclival region and the anterior pons. It combines the more anterior angle of endoscopic approaches along with the enhanced control of open approaches. Further study is necessary before this approach is used clinically.
PubMed: 38327513
DOI: 10.1055/s-0042-1759873 -
Pediatric Neurosurgery 2023Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other... (Review)
Review
INTRODUCTION
Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other pathologies.
CASE PRESENTATION
We report an extremely rare case of a 14-year-old female patient with jugular foramen myxoid chondrosarcoma that was completely removed through microsurgical resection.
CONCLUSION
The primary purpose of the treatment is gross total resection of the chondrosarcomas. However, adjuvant methods such as radiotherapy should additionally be applied in patients who have high-grade diseases or cannot undergo gross total resection because of anatomic localization.
Topics: Female; Humans; Child; Adolescent; Jugular Foramina; Chondrosarcoma; Neoplasms, Connective and Soft Tissue
PubMed: 37231851
DOI: 10.1159/000530990 -
Extradural Transjugular Transsigmoid Approach with High Cervical Exposure for Glomus Jugulare Tumor.Journal of Neurological Surgery. Part... Dec 2019Surgical removal of glomus jugulare tumors is challenging owing to the complex anatomy of the temporal bone and craniocervical region, aggressive tumor invasion into the...
Surgical removal of glomus jugulare tumors is challenging owing to the complex anatomy of the temporal bone and craniocervical region, aggressive tumor invasion into the nearby structures, and their hypervascularity. However, recent advances in skull base techniques, intraoperative neuromonitoring, and radiological interventions have enabled their relatively safe resection, while giving priority to functional preservation. This video demonstrates a case of a glomus jugulare tumor treated by the extradural transjugular transsigmoid approach with high-cervical exposure and tympamoplasty, after preoperative embolization. A 47-year-old woman presented with progressive hearing disturbance, pulsatile tinnitus, and hemifacial spasm. Neuroimaging displayed a hypervascular tumor occupying the temporal bone, extending to the cervical region through the jugular foramen, and to the external auditory canal. Preoperative feeder occlusion was successfully performed without any additional symptoms, while carefully evaluating the provocative test. Near-total resection of the tumor was achieved through the transjugular transsigmoid approach with high-cervical exposure under detailed neuromonitoring, including continuous facial nerve monitoring and auditory brainstem response. In this patient, in whom the tumor did not invade intradurally and the sigmoid sinus was already occluded preoperatively, the sinus was managed only by coagulation, to avoid unnecessary dural opening and the risk of cerebrospinal fluid leakage. Anterior facial nerve rerouting was not required since the tumor removal was accomplished through the corridor above and below the fallopian bridge. The patient had no new neurological deficits, and her pulsatile tinnitus and hemifacial spasm disappeared after the surgery. Her hearing disturbance improved postoperatively. The link to the video can be found at: https://youtu.be/gqf3dxHlv_0 .
PubMed: 31750071
DOI: 10.1055/s-0039-1695057 -
Acta Neurochirurgica Jul 2023Tumors involving the jugular foramen region are challenging for surgical resection. With the development of endoscope in the past decade, surgical approaches assisted by...
BACKGROUND
Tumors involving the jugular foramen region are challenging for surgical resection. With the development of endoscope in the past decade, surgical approaches assisted by endoscope have been widely emerged in the treatment of skull base tumors.
METHODS
Herein, we report a case of jugular foramen schwannoma (Samii type B). Surgical resection was applied via a suboccipital retrosigmoidal craniotomy using surgical microscope assisted by endoscope. Gross total resection was achieved. And the patient recovered without obvious neurological deficits.
CONCLUSIONS
Samii type B schwannomas involving the jugular foramen is approachable by endoscope-assisted surgery.
Topics: Humans; Jugular Foramina; Skull Base Neoplasms; Endoscopy; Craniotomy; Head and Neck Neoplasms; Neurilemmoma
PubMed: 36633684
DOI: 10.1007/s00701-022-05481-7 -
Journal of Neurological Surgery. Part... Apr 2023Skull base neuroanatomy is classically taught using surgical atlases. Although these texts are critical and rich resources for learning three-dimensional (3D)...
Skull base neuroanatomy is classically taught using surgical atlases. Although these texts are critical and rich resources for learning three-dimensional (3D) relationships between key structures, we believe they could be optimized and complemented with step-by-step anatomical dissections to fully meet the learning needs of trainees. Six sides of three formalin-fixed latex-injected specimens were dissected under microscopic magnification. A far lateral craniotomy was performed by each of three neurosurgery resident/fellow at varying stages of training. The study objective was the completion and photodocumentation of the craniotomy to accompany a stepwise description of the exposure to provide a comprehensive, intelligible, and anatomically oriented resource for trainees at any level. Illustrative case examples were prepared to supplement approach dissections. The far lateral approach provides a wide and versatile corridor for posterior fossa operation, with access spanning the entire cerebellopontine angle (CPA), foramen magnum, and upper cervical region. The study includes the following steps: positioning and skin incision, myocutaneous flap, placement of burr holes and sigmoid trough, fashioning of the craniotomy bone flap, bilateral C1 laminectomy, occipital condyle/jugular tubercle drilling, and dural opening. Although more cumbersome than the retrosigmoid approach, a far lateral craniotomy offers unparalleled access to lesions centered lower or more medially in the CPA, as well as those with significant extension into the clival or foramen magnum regions. Dissection-based neuroanatomic guides to operative approaches provide a unique and rich resource for trainees to comprehend, prepare for, practice, and perform complex cranial operations, such as the far lateral craniotomy.
PubMed: 36895809
DOI: 10.1055/a-1760-2528 -
Journal of Neurological Surgery. Part... Jun 2022Standard techniques for primary dural repair following lateral skull base surgery are both technically challenging and time consuming without the potential for...
Standard techniques for primary dural repair following lateral skull base surgery are both technically challenging and time consuming without the potential for primary dural repair. Inadequate closure may result in postoperative cerebrospinal fluid (CSF) leak infectious sequalae. Traditional methods of dural repair rely on secondary obliteration of the CSF fistula. We hypothesized that the use of nonpenetrating titanium microclips may serve as a useful adjunct in primary dural repair or the establishment of an immobile repair layer following lateral skull base surgery. Here, we report a novel technique for primary dural repair using nonpenetrating titanium microclips as an adjunct to standard techniques in a series of six patients with lateral skull base pathologies. A total of six consecutive lateral skull base tumor patients with titanium microclip dural reconstruction were included in our case series. Lateral skull base pathologies represented in this group included two jugular foramen schwannomas, one vestibular schwannoma, one petroclival meningioma, one glomus jugulare paraganglioma, and one jugular foramen chordoid meningioma. To our knowledge, this is the first report on the use of microclips in repairing dural defects following lateral skull base surgery. Surgical outcomes for this small case series suggest that dural repair of the later skull base with nonpenetrating titanium microclips is a useful adjunct in dural repair following lateral skull base surgery.
PubMed: 35832979
DOI: 10.1055/s-0041-1729903 -
Heliyon Feb 2024Preservation of the facial nerve is of great importance in temporal bone surgeries. We intend to investigate the measurements of the radioanatomical factors related to...
INTRODUCTION
Preservation of the facial nerve is of great importance in temporal bone surgeries. We intend to investigate the measurements of the radioanatomical factors related to the position of the facial nerve in accessing jugular foramen and internal carotid artery (ICA) in temporal bone of patients who were candidates for temporal high resolution computed tomography (HRCT) scan.
METHODS
In this correlation cross-sectional study, samples were selected from patients referred to Amir Alam Hospital who were previously candidates for temporal HRCT. Radioanatomic factors were evaluated in three axial, coronal and sagittal views. Analyzes were performed using descriptive statistics, correlation analysis and factor analysis.
RESULTS
A total of 173 samples were investigated. The most reliable radioanatomical factor based on coefficient of variation (CV) was the distance of the 7th nerve to the temporomandibular joint (TMJ) in the inferior to the cochlea in the sagittal view (variable name S2) (CV = 8.1%) and then the distance from the 7th nerve to the TMJ in the inferior section of the cochlea in the axial view (variable name AI3) (CV = 8.4%). Based on correlation analysis and then confirmatory factor analysis, three common latent factors were identified (overall = 0.999).
CONCLUSION
The results of this study can be used for two purposes. First, the direct use of the estimated measures in surgical operations, and the second is more advanced modeling to choose the approach in the surgical operation and how to implement that approach. For the first aim, the two factors AI3 and S2 were the most reliable radioanatomical factors in different people. For the second aim, the three-dimensional understanding of the obtained measurements and the further identification of the anatomical nature of the latent factors can help in choosing the approach in surgery.
PubMed: 38404895
DOI: 10.1016/j.heliyon.2024.e26560