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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Jun 2023To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Fifteen patients with jugular foramen CSA hospitalized in the...
To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Fifteen patients with jugular foramen CSA hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery of Chinese PLA General Hospital from December 2002 to February 2020 were retrospectively collected,of whom 2 were male and 13 were female, aging from 22 to 61 years old. The clinical symptoms and signs, imaging features, differential diagnosis, surgical approaches, function of facial nerve and cranial nerves IX to XII, and surgical outcomes were analyzed. Patients with jugular foramen CSA mainly presented with facial paralysis, hearing loss, hoarseness, cough, tinnitus and local mass. Computed tomography (CT) and magnetic resonance (MR) could provide important information for diagnosis. CT showed irregular destruction on bone margin of the jugular foramen. MR demonstrated iso or hypointense on T1WI, hyperintense on T2WI and heterogeneous contrast-enhancement. Surgical approaches were chosen upon the sizes and scopes of the tumors. Inferior temporal fossa A approach was adopted in 12 cases, inferior temporal fossa B approach in 2 cases and mastoid combined parotid approach in 1 case. Five patients with facial nerve involved received great auricular nerve graft. The House Brackmann (H-B) grading scale was used to evaluate the facial nerve function. Preoperative facial nerve function ranked grade Ⅴ in 4 cases and grade Ⅵ in 1 case. Postoperative facial nerve function improved to grade Ⅲ in 2 cases and grade Ⅵ in 3 cases. Five patients presented with cranial nerves Ⅸ and Ⅹ palsies. Hoarseness and cough of 2 cases improved after operation, while the other 3 cases did not. All the patients were diagnosed CSA by histopathology and immunohistochemistry, with immunohistochemical staining showing vimentin and S-100 positive, but cytokeratin negative in tumor cells. All patients survived during 28 to 234 months' follow-up. Two patients suffered from tumor recurrence 7 years after surgery and received revision surgery. No complications such as cerebrospinal fluid leakage and intracranial infection occurred after operation. Jugular foramen CSA lacks characteristic symptoms or signs. Imaging is helpful to differential diagnosis. Surgery is the primary treatment of jugular foramen CSA. Patients with facial paralysis should receive surgery in time as to restore the facial nerve. Long-term follow-up is necessary after surgery in case of recurrence.
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Facial Paralysis; Diagnosis, Differential; Jugular Foramina; Retrospective Studies; Cough; Hoarseness; Neoplasm Recurrence, Local; Chondrosarcoma
PubMed: 37339893
DOI: 10.3760/cma.j.cn115330-20220607-00334 -
World Neurosurgery Jun 2023There are several landmarks to safely identify the limits of the retrosigmoid approach and its intradural variations; however, there has been little discussion about how...
OBJECTIVE
There are several landmarks to safely identify the limits of the retrosigmoid approach and its intradural variations; however, there has been little discussion about how those landmarks may vary among patients.
METHODS
Patient positions; surface landmarks for the retrosigmoid craniotomy; and structures to recognize for transmeatal, suprameatal, suprajugular, and transtentorial extensions were reviewed.
RESULTS
The position of the dural sinuses in relation to the zygomatic-inion line and digastric notch line is readily identified on magnetic resonance imaging. For transmeatal drilling, the position of the semicircular canals, vestibular aqueduct, and jugular bulb is best evaluated on computed tomography. For suprameatal drilling, the labyrinth and the position and integrity of the carotid canal are relevant for planning the anterior extension of the approach. For transtentorial extension, it is desirable to identify incisural structures. For suprajugular drilling, the position of the jugular bulb, invasion of venous structures, and integrity of the roof of the jugular foramen must be checked preoperatively.
CONCLUSIONS
The retrosigmoid approach is the workhorse of posterior skull base surgery. By recognizing patient-specific variations in known landmarks, the approach may be tailored prevent complications.
PubMed: 37315896
DOI: 10.1016/j.wneu.2023.06.021 -
Frontiers in Physiology 2023Computational fluid dynamics (CFD) assess biological systems based on specific boundary conditions. We propose modeling more advanced hemodynamic metrics, such as core...
Understanding development of jugular bulb stenosis in vein of galen malformations: identifying metrics of complex flow dynamics in the cerebral venous vasculature of infants.
Computational fluid dynamics (CFD) assess biological systems based on specific boundary conditions. We propose modeling more advanced hemodynamic metrics, such as core line length (CL) and critical points which characterize complexity of flow in the context of cerebral vasculature, and specifically cerebral veins during the physiologically evolving early neonatal state of vein of Galen malformations (VOGM). CFD has not been applied to the study of arteriovenous shunting in Vein of Galen Malformations but could help illustrate the pathophysiology of this malformation. Three neonatal patients with VOGM at Boston Children's Hospital met inclusion criteria for this study. Structural MRI data was segmented to generate a mesh of the VOGM and venous outflow. Boundary condition flow velocity was derived from PC-MR sequences with arterial and venous dual velocity encoding. The mesh and boundary conditions were applied to model the cerebral venous flow. We computed flow variables including mean wall shear stress (WSSmean), mean OSI, CL, and the mean number of critical points (nCrPointsmean) for each patient specific model. A critical point is defined as the location where the shear stress vector field is zero (stationary point) and can be used to describe complexity of flow. The division of flow into the left and right venous outflow was comparable between PC-MR and CFD modeling. A high complexity recirculating flow pattern observed on PC-MR was also identified on CFD modeling. Regions of similar WSSmean and OSImean (<1.3 fold) in the left and right venous outflow channels of a single patient have several-fold magnitude difference in higher order hemodynamic metrics (> 3.3 fold CL, > 1.7 fold nCrPointsmean). Specifically, the side which developed JBS in each model had greater nCrPointsmean compared to the jugular bulb with no stenosis (VOGM1: 4.49 vs. 2.53, VOGM2: 1.94 vs. 0, VOGM3: 1 vs. 0). Biologically, these regions had subsequently divergent development, with increased complexity of flow associating with venous stenosis. Advanced metrics of flow complexity identified in computational models may reflect observed flow phenomena not fully characterized by primary or secondary hemodynamic parameters. These advanced metrics may indicate physiological states that impact development of jugular bulb stenosis in VOGM.
PubMed: 37275225
DOI: 10.3389/fphys.2023.1113034 -
Journal of Cerebral Blood Flow and... Oct 2023Brain fluid dynamics remains poorly understood with central issues unresolved. In this study, we first review the literature regarding points of controversy, then pilot...
Brain fluid dynamics remains poorly understood with central issues unresolved. In this study, we first review the literature regarding points of controversy, then pilot study if conventional MRI techniques can assess brain fluid outflow pathways and explore potential associations with small vessel disease (SVD). We assessed 19 subjects participating in the Mild Stroke Study 3 who had FLAIR imaging before and 20-30 minutes after intravenous Gadolinium (Gd)-based contrast. Signal intensity (SI) change was assessed semi-quantitatively by placing regions of interest, and qualitatively by a visual scoring system, along dorsal and basal fluid outflow routes. Following i.v. Gd, SI increased substantially along the anterior, middle, and posterior superior sagittal sinus (SSS) (82%, 104%, and 119%, respectively), at basal areas (cribriform plate, 67%; jugular foramina, 72%), and in narrow channels surrounding superficial cortical veins separated from surrounding cerebrospinal fluid (CSF) (96%) (all p < 0.001). The SI increase was associated with higher intraparenchymal perivascular spaces (PVS) scores (Std. Beta 0.71, p = 0.01). Our findings suggests that interstitial fluid drainage is visible on conventional MRI and drains from brain parenchyma via cortical perivenous spaces to dural meningeal lymphatics along the SSS remaining separate from the CSF. An association with parenchymal PVS requires further research, now feasible in humans.
Topics: Humans; Pilot Projects; Brain; Magnetic Resonance Imaging; Stroke
PubMed: 37254892
DOI: 10.1177/0271678X231179555 -
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 -
Operative Neurosurgery (Hagerstown, Md.) Sep 2023The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and...
BACKGROUND AND OBJECTIVES
The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and lateral exposure than the extreme lateral and endoscopic endonasal approach, respectively. We describe the microsurgical anatomy of ALA with cadaveric specimens and report our clinical experience for benign JF tumors with predominant extracranial extension.
METHODS
A stepwise and detailed microsurgical neurovascular anatomy of ALA was explored with cadaveric specimens. Then, the clinical results of 7 consecutive patients who underwent ALA for benign JF tumors with predominant extracranial extension were analyzed.
RESULTS
A hockey stick skin incision is made along the superior nuchal line to the anterior edge of the sternocleidomastoid muscle (SCM). ALA involves layer-by-layer muscle dissection of SCM, splenius capitis, digastric, longissimus capitis, and superior oblique muscles. The accessory nerve runs beneath SCM and is found at the posterior edge of the digastric muscle. The internal jugular vein (IJV) is lateral to and at the level of the accessory nerve. The occipital artery passes over the longissimus capitis muscle and IJV and into the external carotid artery, which is lateral and superficial to IJV. The internal carotid artery (ICA) is more medial and deeper than external carotid artery and is in the carotid sheath with the vagus nerve and IJV. The hypoglossal and vagus nerves run along the lateral and medial side of ICA, respectively. Prehigh cervical carotid, prejugular, and retrojugular surgical corridors allow deep and extracranial access around JF. In the case series, gross and near-total resections were achieved in 6 (85.7%) patients without newly developed cranial nerve deficits.
CONCLUSION
ALA is a traditional and invaluable neurosurgical approach for benign JF tumors with predominant extracranial extension. The anatomic knowledge of ALA increases competency in adding anterior and lateral exposure of extracranial JF.
Topics: Humans; Jugular Foramina; Cranial Fossa, Posterior; Accessory Nerve; Head and Neck Neoplasms; Cadaver
PubMed: 37195061
DOI: 10.1227/ons.0000000000000763 -
Cureus Apr 2023This ChatGPT-driven case report describes a unique presentation of neurosarcoidosis. The patient, a 58-year-old female, initially presented with hoarseness and was found...
This ChatGPT-driven case report describes a unique presentation of neurosarcoidosis. The patient, a 58-year-old female, initially presented with hoarseness and was found to have bilateral jugular foramen tumors and thoracic lymphadenopathy. Imaging revealed significant enlargement and thickening of the vagus nerve and a separate mass of the cervical sympathetic trunk. The patient was referred for an ultrasound-guided biopsy of the abnormal neck masses to establish a pathologic diagnosis. The patient subsequently underwent neck dissection for exposure of the vagus nerve and isolation of the great vessels in preparation for a transmastoid approach to the skull base. The presence of multifocal tumors prompted the need for a biopsy, which ultimately revealed sarcoid granulomas in the nervous system. The patient was diagnosed with neurosarcoidosis. This case highlights the potential for sarcoidosis to affect the nervous system, with multiple cranial nerve involvement, seizures, and cognitive impairment. It also emphasizes the need for a combination of clinical, radiological, and pathological findings for an accurate diagnosis of neurosarcoidosis. Additionally, this case highlights the utility of natural language processing (NLP), as the entire case report was written using ChatGPT. This report serves as a comparison of the quality of case reports generated by humans versus NLP algorithms. The original case report can be found in the references.
PubMed: 37181995
DOI: 10.7759/cureus.37368 -
BioMedicine 2023Differentiating jugular foramen from hypoglossal canal in computed tomography (CT) scan is vital for correct diagnosis of posterior fossa pathologies; however, it has...
BACKGROUND
Differentiating jugular foramen from hypoglossal canal in computed tomography (CT) scan is vital for correct diagnosis of posterior fossa pathologies; however, it has been shown that the ability for differentiating these skull base elements is limited. The purpose of this study was to produce a simple algorithm for differentiating the jugular foramen from the hypoglossal canal in axial CT scan on two levels (top level where bony carotid canal is evident and lower level where bony carotid canal is not evident).
METHODS
Data derived from axial CT scan of 250 patients (500 sides) were used for producing algorithm. At top level petro-occipital fissure utilized for recognizing occipital condyle in which hypoglossal canal is located; and, at lower level the distance between the posterior border of the anatomic element (jugular foramen or hypoglossal canal) and the tangent to the anterior bony part is used for producing algorithm.
RESULTS
The mean age of patients was 38.1 ± 19 years. The petro-occipital fissure can be used in all patients for differentiating hypoglossal canal. At lower level the distance between the anterior tangent and the posterior border of the element was significantly lower for hypoglossal canal (P value < 0.001). The distance more than 3.5 mm with sensitivity 83.8% and specificity 97.1% differentiate jugular foramen from hypoglossal canal.
CONCLUSION
Simple algorithms based on quantitative morphologic features of the jugular foramen and hypoglossal canal can be used with high sensitivity and specificity to distinguish these elements.
PubMed: 37168727
DOI: 10.37796/2211-8039.1393 -
Surgical and Radiologic Anatomy : SRA Jul 2023The aim of this study is to morphometrically and morphologically examine the occipital condyle, which is an important anatomical region in terms of surgery and forensic...
PURPOSE
The aim of this study is to morphometrically and morphologically examine the occipital condyle, which is an important anatomical region in terms of surgery and forensic medicine, and its surrounding structures, to evaluate the change in mean values according to gender and age, and to evaluate the correlation of the measurements obtained.
METHODS
180 (90 men, 90 women) CBCT images selected from the archive of Ankara University Faculty of Dentistry. Occipital Condyle length and width, Hypoglossal Canal-Basion distance, Hypoglossal Canal-Opistion distance, Hypoglossal Canal-Occipital Condyle anterior and posterior border distance, Occipital Condyle thickness, Hypoglossal Canal length, the widest diameter of Hypoglossal Canal, the narrowest diameter of the Hypoglossal Canal, the length of the Jugular Tubercle, the width of the Jugular Tubercle, the anterior intercondylar distance, the posterior intercondylar distance, and the Foramen Magnum index were measured. At the same time, the presence of septum or spicule in the hypoglossal canal and protrusion of the occipital condyle were evaluated. The relationship of age, gender, anterior and posterior intercondylar distance, and foramen magnum index measurements with all measurements were examined.
RESULTS
In our study, all measurements were repeated 1 month after the first measurements to evaluate the intra-observer agreement, and the agreement between the obtained measurements and the first measurements was evaluated by calculating the intraclass correlation coefficient and 95% confidence intervals. Men's measurements were found to be significantly higher than women's measurements. When the coefficients of concordance in all measurements were examined, it was observed that there was a perfect concordance.
CONCLUSION
When the results of the study are evaluated, it is seen that the values obtained are generally close to the studies related to CT. Considering this, an idea can be gained as to whether CBCT, which has a lower dose and less cost, can be used as an alternative to CT in studies to be conducted with more comprehensive and different methods in skull base surgical planning.
Topics: Male; Female; Humans; Foramen Magnum; Retrospective Studies; Spiral Cone-Beam Computed Tomography; Occipital Bone; Skull Base
PubMed: 37133538
DOI: 10.1007/s00276-023-03153-4 -
Operative Neurosurgery (Hagerstown, Md.) Aug 2023
Topics: Humans; Jugular Foramina; Head and Neck Neoplasms; Magnetic Resonance Imaging; Neurilemmoma
PubMed: 37133276
DOI: 10.1227/ons.0000000000000732