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Acta Neurochirurgica Apr 2019Jugular foramen tumors, particularly those that are triple dumbbell-shaped with intracranial, intraforaminal, and extracranial extensions, are difficult to access...
BACKGROUND
Jugular foramen tumors, particularly those that are triple dumbbell-shaped with intracranial, intraforaminal, and extracranial extensions, are difficult to access surgically. However, advances in neuroimaging, neuromonitoring, and skull base surgery have enabled their safe resection with lower rates of morbidity and mortality.
METHOD
We share our experience with the surgical technique for the management of triple dumbbell-shaped jugular foramen schwannomas.
CONCLUSION
The infralabyrinthine transjugular transsigmoid approach with high cervical exposure under continuous vagus nerve monitoring enables gross total resection of triple dumbbell-shaped jugular foramen schwannomas, aiming at surgical cure of these benign tumors for appropriately selected patients.
Topics: Humans; Jugular Foramina; Neurilemmoma; Neurosurgical Procedures; Retrospective Studies; Skull Base Neoplasms
PubMed: 30830271
DOI: 10.1007/s00701-019-03860-1 -
AJR. American Journal of Roentgenology Jan 1984The computed tomographic (CT) appearance of the jugular foramen was examined in detail, and anatomic and CT sections were correlated. The pars nervosa and pars...
The computed tomographic (CT) appearance of the jugular foramen was examined in detail, and anatomic and CT sections were correlated. The pars nervosa and pars vascularis were identified, and, with intravenous contrast enhancement, a rapid sequence of scans at a gantry angle of +30 degrees to the canthomeatal line demonstrated cranial nerves IX, X, and XI. The osseous margins of the jugular foramen were best shown by CT at planes of sections parallel and positive (0 degrees - 30 degrees) of the canthomeatal line. CT can be used to evaluate osseous anatomy and the jugular foramen with precision sufficient to confidently exclude an intracanalicular mass.
Topics: Cadaver; Contrast Media; Cranial Nerves; Humans; Occipital Bone; Skull Neoplasms; Temporal Bone; Tomography, X-Ray Computed
PubMed: 6606950
DOI: 10.2214/ajr.142.1.153 -
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 -
World Neurosurgery Jul 2022Approaches to the jugular foramen can be challenging. Adding to this difficulty is the potential for a bony septation to occur in the foramen thus subdividing its...
INTRODUCTION
Approaches to the jugular foramen can be challenging. Adding to this difficulty is the potential for a bony septation to occur in the foramen thus subdividing its contents. Although such bony septations in the jugular foramen are known, the anatomic details of these structures have not been studied well. Therefore, the present anatomic study was performed.
METHODS
One hundred adult human skulls (200 sides) underwent evaluation for the presence or absence of a bony septation within the jugular foramen. The source, morphology, and size were all documented. A classification scheme was developed to better describe the varied types of morphology of the jugular foramen bony septa. Select bony septations were submitted to histologic analysis using hematoxylin and eosin and Masson's trichrome.
RESULTS
Bony bridges were found on 8.5% of sides. These were bilateral in 3% of skulls. Eight (47%) were incomplete (type I). Nine sides (53%) were found to have completely articulated bony bridges (type II) and these had articulation between the bony processes as either touching (type IIa), joint-like (type IIb), or completely fused (type IIc) morphologies. Multiple septa were observed on 2.5% of sides and these were classified as type III septa. Histologically, both incomplete and complete septa were found to be composed of normal bone tissue.
CONCLUSIONS
Our study found significant variations regarding the bony septa of the jugular foramen. Knowledge of this anatomy can be useful for preoperative planning and intraoperative navigation with approaches to the skull base that target pathology of the jugular foramen.
Topics: Adult; Humans; Jugular Foramina; Jugular Veins; Skull; Skull Base
PubMed: 35398325
DOI: 10.1016/j.wneu.2022.04.010 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Jul 2022
Topics: Humans; Jugular Foramina; Jugular Veins; Paraganglioma; Tomography, X-Ray Computed
PubMed: 35866288
DOI: 10.3760/cma.j.cn115330-20210701-00417 -
The Laryngoscope Jan 2019Pathologic involvement of the inferior cochlear vein is a mechanism of sensorineural hearing loss in patients with jugular foramen paraganglioma.
OBJECTIVES/HYPOTHESIS
Pathologic involvement of the inferior cochlear vein is a mechanism of sensorineural hearing loss in patients with jugular foramen paraganglioma.
STUDY DESIGN
Retrospective case-control study.
METHODS
The presenting audiograms, magnetic resonance imaging, and computed tomography were reviewed in 46 subjects with jugular foramen paragangliomas. Four-frequency bone conduction average was compared between the tumor and nontumor ears in each subject to establish the presence of sensorineural hearing loss. Imaging findings for each subject were recorded. Univariate and multivariate statistical analyses were performed to determine which radiographic features were associated with sensorineural hearing loss. Hearing data were analyzed as a continuous variable and as a categorical variable.
RESULTS
Twenty subjects (43.4%) had a bone-conduction pure-tone asymmetry of greater than 15 dB. Inferior cochlear vein involvement was identified in 19 of the 20 (95%) subjects with sensorineural hearing loss. Inferior cochlear vein involvement was found to be a statistically significant predictor of sensorineural hearing loss using univariate and multivariate analyses. Other imaging findings that were statistically significant predictors of sensorineural hearing loss include Glasscock-Jackson stage, Fisch-Mattox stage, hypoglossal canal involvement, jugulo-carotid spin erosion, and petrous carotid canal erosion.
CONCLUSIONS
Involvement of the inferior cochlear vein appears to be a plausible mechanism for sensorineural hearing loss in patients with jugular foramen paraganglioma.
LEVEL OF EVIDENCE
4 Laryngoscope, 129:67-75, 2019.
Topics: Adult; Aged; Aged, 80 and over; Bone Conduction; Case-Control Studies; Cochlea; Female; Glomus Jugulare Tumor; Hearing Loss, Sensorineural; Humans; Male; Middle Aged; Paraganglioma; Retrospective Studies; Veins; Young Adult
PubMed: 30194736
DOI: 10.1002/lary.27343 -
Journal of Neurological Surgery. Part... Jun 2016Introduction Multiple surgical approaches and combinations thereof have been described to gain access to the jugular foramen. In an area laden with important...
Introduction Multiple surgical approaches and combinations thereof have been described to gain access to the jugular foramen. In an area laden with important neurovascular structures, care must be taken in choosing the best surgical approach for treatment of rare pathologies involving this region. Methods This manuscript provides a comprehensive review of the relevant anatomy along with an overview of the various approaches to the jugular foramen. In an attempt to simplify the various concepts, we propose a basic distinction into anterolateral and posterolateral approaches based on the main trajectory targeting the jugular foramen. Conclusion The anatomy surrounding the jugular foramen is exceedingly complex and requires in-depth understanding of skull base and head and neck relationships.
PubMed: 27175322
DOI: 10.1055/s-0035-1567863 -
Radiographics : a Review Publication of... 1997A variety of lesions may occur in the jugular foramen, arising from the structures normally found within the jugular foramen or from contiguous structures. The most...
A variety of lesions may occur in the jugular foramen, arising from the structures normally found within the jugular foramen or from contiguous structures. The most common jugular foramen lesions are nontumoral pseudolesions (eg, asymmetrically enlarged jugular foramen, high or protruding jugular bulb) and tumors (eg, paraganglioma, metastasis). In nontumoral pseudolesions, computed tomography (CT) demonstrates smooth, intact margins of the jugular foramen. Turbulent or slow flow in a high or protruding jugular bulb can result in loss of the flow void and contrast enhancement at magnetic resonance (MR) imaging, thereby mimicking real disease. Use of flow-sensitive techniques or MR angiography will help clarify confusing cases. In cerebral venous thrombosis, CT findings are often normal. At conventional MR imaging, flow-related enhancement and in-plane, turbulent, or slow flow can cause loss of the flow void and thus mimic thrombosis. Consequently, phase-contrast MR venography is the imaging modality of choice in the assessment of cerebral venous thrombosis. Most tumoral lesions of the jugular foramen manifest at CT as areas of infiltrative bone destruction, although schwannoma and meningioma cause smooth enlargement of the jugular foramen. In addition, most of these tumors have low to intermediate signal intensity on T1-weighted MR images and intermediate to high signal intensity on T2-weighted MR images and enhance strongly after the administration of contrast material. Careful analysis of these imaging features and correlation with clinical manifestations can allow a more specific diagnosis.
Topics: Brain Diseases; Cranial Nerve Diseases; Humans; Jugular Veins; Magnetic Resonance Imaging; Occipital Bone; Temporal Bone; Tomography, X-Ray Computed; Vascular Diseases
PubMed: 9308106
DOI: 10.1148/radiographics.17.5.9308106 -
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 -
Medicine May 2019Chordomas are rare malignant neoplasms arised from residual embryonic notochordal tissue, mostly located in the axial midline. Tumors along extra-axial locations in the...
RATIONALE
Chordomas are rare malignant neoplasms arised from residual embryonic notochordal tissue, mostly located in the axial midline. Tumors along extra-axial locations in the head and neck are rare. Chordomas located in the jugular foramen are extremely rare, with a low incidence of 0.2%.
PATIENT CONCERNS
A 64-year-old male with 20 years of dizziness history complaining of 6 months of severe dizziness: significant with the changing of the body posture, vertigo which can be self-remissioned within 1 minute and hearing loss of both ears, without headache, nausea, dysphagia, or otalgia. Computed tomography and magnetic resonance imaging (MRI) were performed before surgery which suggests various possibilities. Immunohistochemistry helped to confirm the final diagnosis.
DIAGNOSES
Immunohistochemistry demonstrated diffuse positivity for S100 (+++), positivity for D2-40 (focal +), EMA (+), and PR (+). Ki-67 labeling index was estimated at 2% focally. The final diagnosis was chordoma.
INTERVENTIONS
The tumor was excised via retro-sigmoid approach without postoperative radiotherapy.
OUTCOMES
Facial paralysis occurred in this case. House-Brackmann facial nerve grading system was used to evaluate the facial paralysis of this patient. It is considered as H-B grade IV. The patient was followed up regularly every month after operation, totally for 9 months. An MRI of the brain was performed 6 months after surgery which shows a small range of abnormal signals similar to the previous MRI in the jugular foramen, suggesting that there may be residual or recurrent tumor. And facial paralysis stays at H-B grade IV without any recovery.
LESSONS
It is a big challenge for us to remove giant tumors located in the jugular foramen because of its unique anatomy. Access should be combined with retro-sigmoid or infra-temporal fossa approach to remove such tumors. Chordomas is a malignant neoplasm which may need radiotherapy after surgery, particularly those with subtotal and partial resection.
Topics: Chordoma; Facial Nerve; Facial Paralysis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Postoperative Complications; Skull Base Neoplasms; Tomography, X-Ray Computed
PubMed: 31124949
DOI: 10.1097/MD.0000000000015713