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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 -
Rare Tumors 2023The author describes a rare case of giant adenoid cystic carcinoma (ACC) mimicking large paraganglioma with lower cranial nerve palsy. A 60-year-old female presented...
The author describes a rare case of giant adenoid cystic carcinoma (ACC) mimicking large paraganglioma with lower cranial nerve palsy. A 60-year-old female presented with a progressive increase in postauricular swelling with unilateral hearing loss, facial deviation, difficulty in swallowing, and hoarseness of voice. MRI brain showed highly vascular infiltrating and osteolytic mass suggestive of large glomus jugulare versus sarcoma. It was completely engulfing the jugular foramen and lower cranial nerves with bony erosion of the jugular foramen and occipital condyle. The whole mastoid was filled with the tumor. On digital subtraction angiography the majority of blood supply was from the occipital branch of the external carotid artery and vertebral artery. The patient underwent percutaneous embolization followed by external carotid ligation and resection of the mass. The postoperative course was uneventful. Histopathology was suggestive of mixed ACCs. The patient received radiotherapy. After 1 year of follow up no recurrence or distant metastasis was noted.
PubMed: 36636105
DOI: 10.1177/20363613221150218 -
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 -
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... 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 -
Surgical and Radiologic Anatomy : SRA Jan 2023During retrosigmoid craniotomy, the mastoid emissary vein (MEV) can be a source of considerable bleeding during the operation, especially when the larger diameter MEV or...
PURPOSE
During retrosigmoid craniotomy, the mastoid emissary vein (MEV) can be a source of considerable bleeding during the operation, especially when the larger diameter MEV or sigmoid sinus is torn. In this study, we evaluated the relevant structure of the MEV for their anatomy and applied the data in surgery to summarize their clinical significance.
METHODS
The posterior craniocervical regions of 15 silicon-injected Chinese human cadaver specimens were dissected to expose the MEV and adjacent structures. Fifty-one patients who were scheduled to undergo retrosigmoid craniotomy were selected. All patients underwent preoperative routine CT of the head. The relevant data were collected on cadaveric anatomy and CT. Eventually, all patients underwent retrosigmoid craniotomy and the MEV was observed during the operation.
RESULTS
In cadaver specimens, the prevalence of the MEV was 90.0%. It originated from the middle and lower parts of the posterior wall of the sigmoid sinus and extended in the posterior direction in the mastoid process, usually having 1-2 external openings (86.7%) and only 1 internal opening. The intraosseous courses of the MEV were classified as straight and curved. The straight type accounted for 57.9%, and the curved type for 42.1%. The mean diameter of the MEV was 1.84 ± 0.85 mm, and the straight length of the MEV inside the mastoid process was 11.93 ± 3.58 mm. In 16.7% and 6.7% of all cadaver specimens, the MEV diameter was greater than 2.5 and 4 mm, respectively. In 51 patients (bilateral), routine head CT scan showed the MEV in 49.0% of the patients, and the MEV diameter was greater than 2.5 and 4 mm, respectively, in 17.6% (18/102) and 3.9% (4/102) of the cases. During surgery (unilateral) in the 51 patients, 48 had the MEV and 3 had no MEV. None of the patients had sigmoid sinus tears or massive bleeding.
CONCLUSION
In the process of retrosigmoid craniotomy, detailed anatomical knowledge of the MEV, well-planned CT scan, and meticulous microsurgical techniques are key for successful operation, which can reduce the occurrence of complications.
Topics: Humans; Mastoid; Skull; Jugular Veins; Cranial Sinuses; Cadaver
PubMed: 36520166
DOI: 10.1007/s00276-022-03060-0 -
Journal of Neurological Surgery. Part... Aug 2022Endolymphatic sac tumors (ELSTs) are rare and indolent tumors that arise from the endolymphatic sac in the posterior petrous ridge. We present a video case report...
Endolymphatic sac tumors (ELSTs) are rare and indolent tumors that arise from the endolymphatic sac in the posterior petrous ridge. We present a video case report illustrating the use of a transotic approach for resection of an expansile ELST. A 25-year-old male presented with a multiyear history of worsening left-sided hearing loss, vertigo, and headaches. Otoscopy revealed a red mass behind an intact tympanic membrane. Computed tomography revealed a large, locally aggressive mass centered in the posterior petrous temporal bone. Magnetic resonance imaging demonstrated a heterogeneously enhancing 2.4 × 3.1 × 2.4 cm tumor that exerted mass effect on the cerebellar surface with extension into the jugular foramen, tympanic cavity, internal auditory canal, and cistern of the cerebellopontine angle. A transotic approach was planned to obtain the necessary generous exposure. Preoperative angiography revealed arterial supply via the ascending pharyngeal and tumor embolization with Onyx was performed. Surgical resection began with a blind-sac closure created from the external auditory canal. The tympanic membrane and malleus were removed and the incustapedial joint was transected. A subtotal petrosectomy was performed for partial tumor exposure. The facial canal and sigmoid sinus were carefully skeletonized and a labrynthectomy was performed. The tumor was resected using a combination of bipolar cautery and blunt and sharp dissection. For closure, an abdominal fat graft was secured with overlying resorbable mesh followed by sequential closure of all skin layers. Histopathologic analysis revealed an ELST. The transotic approach offers wide exposure and facilitates large, complex tumor removal. The link to the video can be found at https://youtu.be/YvhyN8iVi44 .
PubMed: 36474718
DOI: 10.1055/s-0042-1757617 -
Journal of Neurological Surgery Reports Jul 2022We describe the first jugular foramen angiomatoid fibrous histiocytoma (AFH) case and the first treatment with preoperative endovascular embolization. AFH is a rare...
We describe the first jugular foramen angiomatoid fibrous histiocytoma (AFH) case and the first treatment with preoperative endovascular embolization. AFH is a rare intracranial neoplasm, primarily found in pediatric patient extremities. With an increase in AFH awareness and a well-described genetic profile, intracranial prevalence has also subsequently increased. We compare this case to previously reported cases using PubMed/Medline literature search, which was performed using the algorithm ["intracranial" AND "angiomatoid fibrous histiocytoma"] through December 2020 (23 manuscripts with 46 unique cases). An 8-year-old female presented with failure to thrive and right-sided hearing loss. Work-up revealed an absence of right-sided serviceable hearing and a large jugular foramen mass. Angiogram revealed primary arterial supply from the posterior branch of the ascending pharyngeal artery, which was preoperatively embolized. Gross total resection was performed via a translabyrinthine approach. The case presented is unique; the first reported AFH at the jugular foramen and the first reported case utilizing preoperative embolization. Preoperative embolization is a relatively safe technique that can improve the surgeon's ability to perform a maximally safe resection, which may decrease the need for adjuvant radiation in rare skull base tumors in young patients.
PubMed: 36148089
DOI: 10.1055/s-0042-1754320 -
Journal of Clinical Medicine Sep 2022We propose that the appearance of a ptosis of the cerebellar tonsils and syringomyelia is linked to its own hemohydrodynamic mechanisms. We aimed to quantify...
BACKGROUND
We propose that the appearance of a ptosis of the cerebellar tonsils and syringomyelia is linked to its own hemohydrodynamic mechanisms. We aimed to quantify cerebrospinal fluid (CSF) and cerebral blood flow to highlight how neurofluid is affected by Chiari malformations type 1(CMI) and its surgery.
METHODS
We retrospectively included 21 adult patients with CMI who underwent pre- and postoperative phase contrast MRI (PCMRI) during the period from 2001 to 2017. We analyzed intraventricular CSF, subarachnoid spaces CSF, blood, and tonsils pulsatilities.
RESULTS
In preoperative period, jugular venous drainage seems to be less preponderant in patients with syringomyelia than other patients (venous correction factor: 1.49 ± 0.4 vs. 1.19 ± 0.1, = 0.05). After surgery, tonsils pulsatility decreased significantly (323 ± 175 μL/cardiac cycle (CC) vs. 194 ± 130 μL/CC, = 0.008) and subarachnoid CSF pulsatility at the foramen magnum increased significantly (201 ± 124 μL/CC vs. 363 ± 231 μL/CC, = 0.02). After surgery, we found a decrease in venous flow amplitude (5578 ± 2469 mm/s vs. 4576 ± 2084 mm/s, = 0.008) and venous correction factor (1.98 ± 0.3 vs. 1.20 ± 0.3 mm/s, = 0.004).
CONCLUSIONS
Phase-contrast MRI could be a useful additional tool for postoperative evaluation and follow-up, and is complementary to morphological imaging.
PubMed: 36142990
DOI: 10.3390/jcm11185343