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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 -
Journal of Neurosurgery Sep 2018OBJECTIVE The dura mater is made of 2 layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which...
OBJECTIVE The dura mater is made of 2 layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which directly covers the brain and spinal cord. These 2 dural layers join together in most parts of the skull base and cranial convexity, and separate into the orbital and perisellar compartments or into the spinal epidural space to form the extradural neural axis compartment (EDNAC). The EDNAC contains fat and/or venous blood. The aim of this dissection study was to anatomically verify the concept of the EDNAC by focusing on the dural layers surrounding the jugular foramen area. METHODS The authors injected 10 cadaveric heads (20 jugular foramina) with colored latex and fixed them in formalin. The brainstem and cerebellum of 7 specimens were cautiously removed to allow a superior approach to the jugular foramen. Special attention was paid to the meningeal architecture of the jugular foramen, the petrosal inferior sinus and its venous confluence with the sigmoid sinus, and the glossopharyngeal, vagus, and accessory nerves. The 3 remaining heads were bleached with a 20% hydrogen peroxide solution. This procedure produced softening of the bone without modifying the fixed soft tissues, thus permitting coronal and axial dissections. RESULTS The EDNAC of the jugular foramen was limited by the endosteal and meningeal layers and contained venous blood. These 2 dural layers joined together at the level of the petrous and occipital bones and separated at the inferior petrosal sinus and the sigmoid sinus, and around the lower cranial nerves, to form the EDNAC. Study of the dural sheaths allowed the authors to describe an original compartmentalization of the jugular foramen in 3 parts: 2 neural compartments-glossopharyngeal and vagal-and the interperiosteodural compartment. CONCLUSIONS In this dissection study, the existence of the EDNAC concept in the jugular foramen was demonstrated, leading to the proposal of a novel 3-part compartmentalization, challenging the classical 2-part compartmentalization, of the jugular foramen.
Topics: Carotid Artery, Internal; Cranial Nerves; Cranial Sinuses; Dissection; Dura Mater; Epidural Space; Humans; Jugular Veins; Meninges; Periosteum; Skull
PubMed: 28885117
DOI: 10.3171/2017.1.JNS161890 -
The microsurgical anatomy of the glossopharyngeal nerve with respect to the jugular foramen lesions.Neurosurgical Focus Aug 2004Removal of lesions involving the jugular foramen region requires detailed knowledge of the anatomy and anatomical landmarks of the related area, especially the lower... (Review)
Review
Removal of lesions involving the jugular foramen region requires detailed knowledge of the anatomy and anatomical landmarks of the related area, especially the lower cranial nerves. The glossopharyngeal nerve courses along the uppermost part of the jugular foramen and is well hidden in the deep layers of the neck, making this nerve is the most difficult one to identify during surgery. It may be involved in various pathological entities along its course. The glossopharyngeal nerve can also be compromised iatrogenically during the surgical treatment of such lesions. The authors define landmarks that can help identify this nerve during surgery and discuss the types of lesions that may involve each portion of the glossopharyngeal nerve.
Topics: Cerebellopontine Angle; Cervical Atlas; Cranial Nerve Neoplasms; Endarterectomy, Carotid; Glomus Jugulare Tumor; Glossopharyngeal Nerve; Glossopharyngeal Nerve Diseases; Glossopharyngeal Nerve Injuries; Humans; Intraoperative Complications; Microsurgery; Neurilemmoma; Skull Base
PubMed: 15329018
DOI: 10.3171/foc.2004.17.2.3 -
Head & Neck Apr 2016The variety of surgical approaches to jugular schwannomas makes selection of an approach difficult. The purpose of this study was to define the anatomic elements of...
BACKGROUND
The variety of surgical approaches to jugular schwannomas makes selection of an approach difficult. The purpose of this study was to define the anatomic elements of these approaches.
METHODS
Ten adult cadaveric heads were examined.
RESULTS
There are lateral, posterior, and anterior routes that access various parts of the jugular foramen. Removal of the jugular process of the occipital bone provides access to the posterior aspect of the foramen, the infralabyrinthine mastoidectomy provides access to the lateral edge and dome of the jugular bulb, and the preauricular approaches provide access to the anterior margin of the bulb and foramen. Additions to these approaches may include cervical and vertebral artery exposure, facial nerve transposition, foramen magnum exposure, and external canal and condylar resection.
CONCLUSION
An understanding of the anatomy of the jugular foramen is crucial in achieving total tumor removal while minimizing risk. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1041-E1053, 2016.
Topics: Cadaver; Facial Nerve; Humans; Microsurgery; Neurilemmoma; Neurosurgical Procedures; Occipital Bone; Temporal Bone
PubMed: 26045057
DOI: 10.1002/hed.24156 -
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 -
Neurosurgical Focus Apr 2019Posterior fossa dural arteriovenous fistulas (dAVFs) are rare vascular malformations. They carry a significant risk of hemorrhage if associated with cortical venous...
Posterior fossa dural arteriovenous fistulas (dAVFs) are rare vascular malformations. They carry a significant risk of hemorrhage if associated with cortical venous reflux. A 70-year-old man presented with right-sided medullary hemorrhage with pronounced Wallenberg syndrome. Angiography demonstrated right jugular foramen dAVF with direct brainstem venous reflux (Cognard IV). It was fed from multiple branches of the external carotid artery and the vertebral artery, and draining into the ascending pontomesencephalic vein. Primary two-stage transarterial embolization was performed with near-total occlusion of the fistula to prevent it from rebleeding in the acute phase. Because of the patient's significant neurological deficit, the surgery was deferred to later and if the DAVF showed further progression. Follow-up angiography 8 months later demonstrated obvious recurrence and progression of the fistula from adjacent feeders. In the meantime, the patient had a remarkable recovery from the Wallenberg symptoms. To achieve complete occlusion of the fistula, a right far lateral approach was chosen with complete disconnection of the fistula. Postoperative angiography confirmed complete occlusion of the fistula, and the patient remained intact from the procedure.The video can be found here: https://youtu.be/DJvpa8G4olc.
Topics: Aged; Central Nervous System Vascular Malformations; Cerebral Angiography; Cerebral Veins; Embolization, Therapeutic; Humans; Jugular Foramina; Male; Vascular Surgical Procedures
PubMed: 30939436
DOI: 10.3171/2019.2.FocusVid.18667 -
Journal of Clinical Monitoring and... Dec 2022Schwannoma, a tumor originating from the peripheral nervous system, may arise from the vagus nerve, although it is not very often. Injury of the vagus nerve by surgical... (Review)
Review
PURPOSE
Schwannoma, a tumor originating from the peripheral nervous system, may arise from the vagus nerve, although it is not very often. Injury of the vagus nerve by surgical attempts may have consequences that will seriously affect the patient's quality of life. In recent years, continuous monitoring of the laryngeal adductor reflex (LAR) has become a promising methodology for evaluating vagus nerve function intraoperatively. We refer to our experience changing our surgical strategy due to concurrent deterioration in LAR and CoMEPs intraoperatively. We also provide a literature review and summarize the current knowledge of this technique.
METHODS
The LAR was elicited and recorded by an electromyographic endotracheal tube in a 36-year-old man diagnosed with vagal nerve schwannoma. Subdermal needle electrodes were placed in both cricothyroid (CTHY) muscles for corticobulbar motor evoked potentials (CoMEPs) recording.
RESULTS
Recordings of ipsilateral LAR and CTHY CoMEPs were obtained despite preoperative ipsilateral cord vocalis weakness. The surgical strategy was altered after the simultaneous decrease of CTHY CoMEPs and LAR amplitudes, and the surgery was completed with subtotal resection. No additional neurological deficit was observed in the patient except dysphonia, which resolved within a few weeks after the surgery.
CONCLUSIONS
We conclude that LAR with vagal nerve CoMEPs are two complementary methods and provide reliable information about the functional status of the vagus nerve during surgery.
Topics: Male; Humans; Adult; Evoked Potentials, Motor; Quality of Life; Jugular Foramina; Reflex; Vagus Nerve; Neurilemmoma; Electromyography
PubMed: 35763166
DOI: 10.1007/s10877-022-00880-8 -
Journal of Craniovertebral Junction &... 2016Tumors affecting structures in the vicinity of jugular foramen such as glomus jugulare require microsurgical approach to access this region. These tumors tend to alter...
INTRODUCTION
Tumors affecting structures in the vicinity of jugular foramen such as glomus jugulare require microsurgical approach to access this region. These tumors tend to alter the normal architecture of the jugular foramen by invading it. Therefore, it is not feasible to have correct anatomic visualization of the foramen in the presence of such pathologies. Hence, a comprehensive knowledge of the jugular foramen is needed by all the neurosurgeons while doing surgery in this region.
AIM
Due to the inadequate knowledge of the accurate morphology of the jugular foramen in different sexes, the aim of this osteological study was to provide a complete morphometry including gender differences and describe some morphological characteristics of the jugular foramen in an adult Indian population.
MATERIALS AND METHODS
The study was done on 114 adult human dry skulls (63 males and 51 females) collected from the osteology museum in the department. Various dimensions of both endo- and exocranial aspect of jugular foramen were measured. Presence and absence of domed bony roof of jugular fossa and compartmentalization of jugular foramen were also noticed. Statistical analysis was done using Chi-square test and Student's -test in SPSS version 23.
RESULTS
All the parameters of right jugular foramen were greater than the left side, except the distance of stylomastoid foramen from lateral margin of jugular foramen (SMJF) which was greater on the left side. Gender differences between various measurements of jugular foramen, presence of dome of jugular fossa, and compartmentalization patterns were reported.
CONCLUSION
This study gives knowledge about the various parameters, anatomical variations of jugular foramen in both sexes of an adult Indian population, and its clinical impact on the surgeries of this region.
PubMed: 27891036
DOI: 10.4103/0974-8237.193268 -
Surgical and Radiologic Anatomy : SRA Feb 2021To investigate the feasibility of an endoscopic surgical approach through the neck to the jugular foramen, to determine the relevant techniques and extent of exposure,...
OBJECTIVES
To investigate the feasibility of an endoscopic surgical approach through the neck to the jugular foramen, to determine the relevant techniques and extent of exposure, and to provide a new surgical approach with minimal trauma.
METHODS
Nine cadaveric head specimens with attached necks were fixed with 10% formalin solution. Two of the heads were fixed and injected with colored silicone rubber. Through the dissection of these cadaver head and neck specimens, we designed a surgical approach from the neck to the jugular foramen area with the use of a neuroendoscope and performed simulated surgery to determine which anatomical structures were encountered in the approach.
RESULTS
The posterior aspect of the internal jugular vein is adjacent to the rectus capitis lateralis. The internal carotid artery is anteromedial to the internal jugular vein, with the glossopharyngeal nerve, accessory nerve, vagus nerve and hypoglossal nerve in between. Removal of the rectus capitis lateralis can reveal the jugular process, and exposing the space between the superior oblique muscle and the jugular process can reveal the atlanto-occipital joint. Drilling through the occipital condyle can facilitate entrance into the skull, expose the flank of the medulla oblongata, and reveal the medullary olive and accessory nerve, vagus nerve, hypoglossal nerve, vertebral artery and posterior inferior cerebellar artery. Removing the jugular vein and completely opening the posterior wall of the jugular foramen can expose the inferior wall of the jugular bulb and the inferior wall of the sigmoid sinus. Drilling through the styloid process, which is lateral to the internal jugular vein, can expose the lateral area and upper wall of the jugular bulb and cranial nerves (CN) IX-XII; and near the top of the jugular bulb, the tympanic cavity and the external auditory canal can be easily opened.
CONCLUSION
Endoscopic surgical access from the neck to the jugular foramen is feasible. This surgical approach can simultaneously remove intracranial and extracranial tumors and can also be used to remove tumors in the ventral region of the occipital foramen and the hypoglossal canal. Furthermore, this approach is advantageous in that minimal trauma is inflicted. With judicious patient selection, this approach may have significant advantages and may be used as a primary or secondary surgical approach in the future. Nonetheless, this approach is still in development in a laboratory setting, and further research and improvements are needed before facing more complicated situations in clinical practice.
Topics: Cadaver; Endoscopy; Feasibility Studies; Humans; Jugular Foramina; Neck; Neurosurgical Procedures; Patient Selection
PubMed: 32959079
DOI: 10.1007/s00276-020-02574-9 -
Neuro-Chirurgie Jul 2022The jugular foramen (JF) can be the site of several tumours. Paragangliomas, schwannomas and meningiomas are the most commonly reported. We describe a case of...
BACKGROUND
The jugular foramen (JF) can be the site of several tumours. Paragangliomas, schwannomas and meningiomas are the most commonly reported. We describe a case of melanocytoma originating from the JF and presenting with an accessory nerve palsy.
ILLUSTRATIVE CASE
A 48-year-old woman presented with a 6-month history of cervical and left shoulder pain with wasting and weakness of the left trapezius. A Magnetic Resonance Imaging (MRI) showed a T1-hyperintense, T2-isointense, heterogeneously enhancing lesion involving the left JF and extending into the cerebello-medullary and cerebello-pontine cisterns. A retrosigmoid craniotomy was performed and a near-total removal achieved. The accessory nerve was involved by tumour and could not be preserved. Given the diagnostic uncertainty between melanotic schwannoma, metastatic melanoma and meningeal melanocytoma, next generation sequencing and genome-wide DNA methylation arrays were performed, documenting a mutation in GNA11 (c.6226A>T, p. Gln209Leu) and a methylation profile consistent with melanocytoma. The patient underwent adjuvant fractionated radiotherapy of the tumour remnant. A follow-up MRI 4 years after surgery did not show any tumour recurrence.
CONCLUSIONS
The differential diagnosis of skull base pigmented tumours can be challenging, particularly when they occur in unusual locations such as the JF. They can be misdiagnosed given their similar clinical, neuroradiological and pathological features if anatomy of the site of origin is not carefully considered and molecular tests are not performed, leading to erroneous treatment and follow-up planning.
Topics: Adult; Female; Humans; Jugular Foramina; Magnetic Resonance Imaging; Meningeal Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Skull Base Neoplasms
PubMed: 34157339
DOI: 10.1016/j.neuchi.2021.06.001