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Neurosurgical Review Jan 2006The preoperative diagnosis of a jugular foramen tumor may be challenging, since a large variety of unusual lesions may be located in this region. These tumors may be... (Review)
Review
The preoperative diagnosis of a jugular foramen tumor may be challenging, since a large variety of unusual lesions may be located in this region. These tumors may be classified as primary lesions (which are located in the jugular foramen or extend from the jugular foramen into the surrounding structures) and as secondary lesions (that extend from the surrounding structures into the jugular foramen). Primary tumors include glomus jugulare tumors, schwannomas, meningiomas and peripheral primitive neuroectodermal tumors, while secondary tumors comprise chordomas, chondrosarcomas, chondroblastomas, giant-cell tumors, cholesterol granulomas, giant cholesterol cyst, endolymphatic sac tumors, reactive myofibroblastic tumors, temporal bone carcinomas and metastases. Accurate preoperative radiological suspicion is of great value for preoperative patient counseling and has a direct impact on the surgical planning in these cases. The present study describes and discusses the main differentiating imaging features of lesions involving the jugular foramen, whose accurate preoperative radiological evaluation is essential for proper surgical planning.
Topics: Brain Neoplasms; Diagnosis, Differential; Glomus Jugulare Tumor; Humans; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neurosurgical Procedures; Occipital Bone; Skull Base Neoplasms; Skull Neoplasms; Temporal Bone; Tomography, X-Ray Computed
PubMed: 16283211
DOI: 10.1007/s10143-005-0420-7 -
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 -
Journal of Neurosurgical Sciences Sep 1997The occurrence of a meningioma within the jugular foramen is very rare. We present the case of a 33-year-old man who presented with five-year history of hoarseness and... (Review)
Review
The occurrence of a meningioma within the jugular foramen is very rare. We present the case of a 33-year-old man who presented with five-year history of hoarseness and was found to have paralysis of lower four cranial nerves on the left. High resolution computed tomography showed a dumbbell shaped tumor of the left jugular foramen extending intracranially over the jugular tubercle and extracranially into the parapharyngeal space. The patient underwent staged neuro-otological surgery and the mass was removed subtotally with no recurrence in six years. Histopathologic diagnosis was transitional meningioma. Our review of the literature revealed 33 previously reported cases. Four of these cases had neurofibromatosis. All but one underwent some form of otolaryngologic surgery. Although twenty had an intracranial component to their tumor, only 11 had a craniotomy. The majority of the tumors were meningothelial meningiomas (60%). Only two cases were malignant meningiomas. We reviewed the clinical and radiological characteristics and summarized the benefits and pitfalls of existing surgical options.
Topics: Adult; Humans; Jugular Veins; Male; Meningeal Neoplasms; Meningioma; Tomography, X-Ray Computed
PubMed: 9444582
DOI: No ID Found -
The Laryngoscope Jul 2022Transnasal exposure of the jugular foramen region (JFR) often requires transection of the Eustachian tube (ET). This study aims to propose a transoral corridor for...
OBJECTIVES/HYPOTHESIS
Transnasal exposure of the jugular foramen region (JFR) often requires transection of the Eustachian tube (ET). This study aims to propose a transoral corridor for access to the JFR with preservation of the ET.
STUDY DESIGN
Cadaveric dissection and case illustration.
METHODS
An endoscopic transoral approach for exposure of the JFR was performed on 5 cadaveric specimens (10 sides). Six patients who underwent a transoral resection of schwannoma within the JFR were retrospectively analyzed.
RESULTS
Direct exposure of the JFR with a 0° scope via a transoral approach was feasible, and the internal carotid artery and lower cranial nerves could be adequately exposed, and preservation of the ET was achieved in all 10 sides of the cadaveric specimens. For six patients with JFR tumors, the transoral approach provided adequate access to achieve a gross total resection with ET preservation. Intraoperative cerebral spinal fluid (CSF) leak was encountered in one patient, and a multilayer reconstruction was employed for reconstruction. No operative field or intracranial infection, persistent CSF leak, or emergent airway issues occurred. No recurrence occurred in this cohort with an average follow-up of 12 months.
CONCLUSIONS
The transoral approach provided a reliable corridor for access into the JFR with preservation of the ET. For select lesions with expansion into the posterior cranial fossa, a transoral corridor may serve as an alternative for tumor extirpation.
LEVEL OF EVIDENCE
4 Laryngoscope, 132:1374-1380, 2022.
Topics: Cadaver; Cerebrospinal Fluid Leak; Cranial Fossa, Posterior; Eustachian Tube; Humans; Jugular Foramina; Retrospective Studies
PubMed: 35297505
DOI: 10.1002/lary.30077 -
Operative Neurosurgery (Hagerstown, Md.) Aug 2022Among the several approaches described to the jugular foramen (JF), the retrosigmoid infralabyrinthine (suprajugular) approach was one of the most recently described.
BACKGROUND
Among the several approaches described to the jugular foramen (JF), the retrosigmoid infralabyrinthine (suprajugular) approach was one of the most recently described.
OBJECTIVE
To describe the indications, limitations, and operative nuances of the suprajugular approach.
METHODS
We provided a pertinent review of the anatomy, indications, preoperative evaluation, surgical steps and nuances, and postoperative management.
RESULTS
The suprajugular approach is suitable for tumors occupying the intracranial compartment with limited extension into the JF. Volume, width, and configuration of the foramen dictate the feasibility of the approach. Tumors invading the venous system are not suitable for this approach. Preoperative 3-dimensional MRI and computed tomography are used to evaluate intrajugular extension, relationship between the tumor and the jugular bulb (JB), venous system invasion, and shape of the JF. During surgery, exposition of the entire posterior border of the sigmoid sinus is needed and removing the bone over the JB. After identification of the JF, the jugular notch and intrajugular process of the roof of the foramen are removed and intrajugular resection is completed. In cases of high-riding JB, it may be gently pushed down to allow visualization of the anterior foramen. In cases of JB laceration, it may be repaired using a muscle patch and usually does preclude further resection.
CONCLUSION
The suprajugular approach is variation of the retrosigmoid approach that, when properly indicated, provides excellent exposure of the medial JF, with most anatomical variations and intraoperative complications predicted by a comprehensive preoperative evaluation.
Topics: Humans; Jugular Foramina
PubMed: 35838460
DOI: 10.1227/ons.0000000000000259 -
World Neurosurgery Jul 2019This 3-dimensional histologic study aimed to provide a precise description of the meningeal structures in the jugular foramen.
OBJECTIVE
This 3-dimensional histologic study aimed to provide a precise description of the meningeal structures in the jugular foramen.
METHODS
22 posterior skull base tissue blocks containing the jugular foramen region were obtained from 11 human cadaveric heads. These blocks were plastinated and cut into serial sections. After staining, these sections were examined under an optical microscope and used to reconstruct a 3-dimensional visualization model.
RESULTS
At the intracranial orifice of the jugular foramen, the meningeal dura formed 2 separate dural perforations: the glossopharyngeal meatus and the vagal meatus. The arachnoid extended into 2 dural meatuses and terminated at the inferior ganglion of the glossopharyngeal nerve in the glossopharyngeal meatus and the superior ganglion of the vagus nerve in the vagal meatus. At the intraforaminal part of the jugular foramen, the meningeal dura encased the glossopharyngeal nerve to form a dural sheath while encasing the vagus and accessory nerves to form a dural network. At the extracranial orifice of the jugular foramen, the dural wall of the jugular bulb extended downward to form a dense connective tissue sheath. The initial end of the internal jugular vein invaginated into this sheath and fused with the jugular bulb.
CONCLUSIONS
Knowledge of the anatomy of the meningeal architecture of the jugular foramen can be helpful in avoiding surgical complications of the lower cranial nerves when this complex area is approached.
Topics: Accessory Nerve; Aged; Aged, 80 and over; Cranial Nerves; Female; Glossopharyngeal Nerve; Humans; Jugular Foramina; Jugular Veins; Male; Medulla Oblongata; Meninges; Middle Aged; Skull Base; Vagus Nerve
PubMed: 30954756
DOI: 10.1016/j.wneu.2019.03.272 -
Neuropediatrics Oct 2021Multiple lower cranial nerve palsies have been attributed to occipital condyle fractures in older children and adults, but no clinical details of other possible...
BACKGROUND
Multiple lower cranial nerve palsies have been attributed to occipital condyle fractures in older children and adults, but no clinical details of other possible mechanisms have been described in infants.
CASE REPORT
A 33-month-old boy suffered blunt head trauma. A bilateral skull base fracture was diagnosed, with favorable outcome during the first days after trauma. On the sixth day, the patient began to refuse drinking and developed hoarseness. Physical examination and additional investigations revealed paralysis of left VII, IX, X, and XI cranial nerves. A follow-up computed tomography (CT) scan disclosed a left petrous bone fracture involving the lateral margin of the jugular foramen, and a cranial magnetic resonance imaging (MRI) study showed a left cerebellar tonsil contusion. He improved after methylprednisolone was started. Three months later, he was asymptomatic, although mild weakness and atrophy of the left sternocleidomastoid and trapezius muscles remained 1 year later.
DISCUSSION
A posttraumatic "jugular foramen syndrome" is rare in children, but it has been reported shortly after occipital condyle fracture, affecting mainly IX, X, and XI cranial nerves. In this toddler, delayed symptoms appeared with unilateral involvement. While an occipital fracture was ruled out, neuroimaging findings suggest the hypothesis of a focal contusion as a consequence of a injury.
CONCLUSION
This exceptional case highlights the importance of gathering physical examination, anatomical correlation, and neuroimaging to yield a diagnosis.
Topics: Adult; Child; Child, Preschool; Cranial Nerve Diseases; Humans; Jugular Foramina; Male; Occipital Bone; Tomography, X-Ray Computed
PubMed: 33511597
DOI: 10.1055/s-0040-1722684 -
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 -
The Journal of Otolaryngology Dec 1980The jugular foramen syndrome (JFS) specifically refers to paralysis to the IX-XIth cranial nerves. In a more general meaning, however, any combination of palsies...
The jugular foramen syndrome (JFS) specifically refers to paralysis to the IX-XIth cranial nerves. In a more general meaning, however, any combination of palsies affecting the last four cranial nerves has been referred to as a JFS. The anatomy of the jugular foramen and the structures which traverse it are reviewed. Two cases histories of a JFS are described; the first with chronic otitis media, and the second with a glomus tumor. A variety of neoplasms, vascular insults, infections, and trauma have been reported to cause JFS. Treatment is directed toward the underlying cause. A variety of radiological techniques which are useful in the investigation of JFS are outlined.
Topics: Accessory Nerve; Adult; Aged; Cranial Nerves; Female; Glomus Jugulare Tumor; Glossopharyngeal Nerve; Humans; Lymphadenitis; Male; Otitis Media; Paralysis; Syndrome; Vagus Nerve; Vascular Diseases; Wounds and Injuries
PubMed: 7206037
DOI: No ID Found