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World Neurosurgery: X Apr 2023The distinctive bilateral carotid sheaths (CS) reside in the neck region and form part of the deep cervical fasciae. Aspects of the CS anatomy are controversial, most... (Review)
Review
OBJECTIVES
The distinctive bilateral carotid sheaths (CS) reside in the neck region and form part of the deep cervical fasciae. Aspects of the CS anatomy are controversial, most notably its specific attachment sites and fascial makeup, which are key determinants for the spread of tumours and infections and surgical planning. This review aimed to organise the pertinent aspects relating to CS anatomy and pathology, explore their clinical relevance and highlight areas of disagreement in the literature.
METHODS
A narrative review identified key papers relating to CS anatomy, histology, embryology, pathology and clinical and surgical significance using PubMed and Google Scholar. This was supported by a systematic review focused on the fascia forming the CS which was conducted using PubMed, Web of Science and Core Collection which yielded 22 papers.
RESULTS
and Discussion: The CS surrounds the internal carotid artery, internal jugular vein, cranial nerves IX - XII, lymph nodes and nervous plexuses as they course from the jugular foramen superiorly down along into the mediastinum inferiorly. There are contradicting descriptions regarding the CS attachments at the extracranial skull base and within the mediastinum. Author descriptions of the CS fasciae are complex, varied and incongruent. Pathologies affecting the CS include malignancies of the nerves, vascular lesions and utilisation of the CS space as a corridor for the spread of deep neck infections.
CONCLUSION
This paper collates and presents pertinent anatomical and clinical aspects regarding the CS. A proper knowledge of the CS anatomy and structural relationships will optimise surgical approaches and orientation when operating within the region.
PubMed: 37081926
DOI: 10.1016/j.wnsx.2023.100158 -
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 -
Journal of Craniovertebral Junction &... Jul 2014Jugular foramen of human skull is one of the most interesting foramina. It is a complex bony canal, numerous vital structures, including nerves and vessels are...
OBJECTIVE
Jugular foramen of human skull is one of the most interesting foramina. It is a complex bony canal, numerous vital structures, including nerves and vessels are transmitted through it. Most of the intracranial and extra cranial lesions of posterior cranial fossa might affect the structures in jugular foramen in addition to intrinsic abnormalities. As the neurosurgeons have become courageous in approaching this area, so there is a need to become familiar with this area. Hence, the present study was done to examine the anatomy of jugular foramen, including its morphological features and dimensions.
MATERIALS AND METHODS
The study was carried out on 50 dried skulls. 100 jugular foramina were studied on both right and left side of skulls. The length, width of jugular foramen and width and depth of jugular fossa were measured using vernier calipers. Presence of dome, complete and incomplete septation was also looked for.
RESULTS
The mean right and left anteroposterior diameter, latero-medial diameter, area, jugular fossa width, depth in our study was 11.22, 16.52, 187.34, 6.83, 11.58 mm and 9.52, 16.02, 153.2, 5.69, 11.13 mm. Dome was present in jugular foramen in 74% on the right side and 58% on the left side. Complete septation in jugular foramen is seen in 44% on the right side and 42% on the left side.
CONCLUSION
This study will help the neurosurgeons while doing surgery in this region.
PubMed: 25336833
DOI: 10.4103/0974-8237.142305 -
Interventional Neuroradiology : Journal... Aug 2018The lateral foramen magnum region is defined as the bilateral occipital area that runs laterally up to the jugular foramen. The critical vasculatures of this region are... (Review)
Review
The lateral foramen magnum region is defined as the bilateral occipital area that runs laterally up to the jugular foramen. The critical vasculatures of this region are not completely understood. Dural arteriovenous fistulas that occur in this region are rare and difficult to treat. Therefore, we searched PubMed to identify all relevant previously published English language articles about lateral foramen magnum dural arteriovenous fistulas, and we performed a review of this literature to increase understanding about these fistulas. Four types of dural arteriovenous fistulas occur in the lateral foramen magnum region. These include anterior condylar confluence and anterior condylar vein dural arteriovenous fistulas, posterior condylar canal dural arteriovenous fistulas, marginal sinus dural arteriovenous fistulas, and jugular foramen dural arteriovenous fistulas. These dural arteriovenous fistulas share similar angioarchitectures and clinical characteristics. The clinical presentations of lateral foramen magnum dural arteriovenous fistulas include pulsatile tinnitus, intracranial hemorrhage, myelopathy, orbital symptoms, and cranial nerve palsy. Currently, head computed tomography, computed tomography angiography, magnetic resonance imaging, magnetic resonance angiography and digital subtraction angiography (DSA) are useful for diagnosing dural arteriovenous fistulas, and of these, DSA remains the "gold standard." Most lateral foramen magnum dural arteriovenous fistulas need to be treated due to their aggressive symptoms, and transvenous embolization presents the best options. During treatment, it is critical to accurately place the microcatheter into the fistula point, and intraoperative integrated computed tomography and DSA data are very helpful. Other treatments, such as transarterial embolization, microsurgery or conservative treatment, can also be chosen. After appropriate treatment, most patients with lateral foramen magnum dural arteriovenous fistulas achieve satisfactory outcomes.
Topics: Central Nervous System Vascular Malformations; Foramen Magnum; Humans
PubMed: 29726736
DOI: 10.1177/1591019918770768 -
Journal of Neurological Surgery. Part... Jun 2022Invasion depth influences the choice for extirpation of nasopharyngeal malignancies. This study aims to validate the feasibility of endoscopic endonasal resection of...
Invasion depth influences the choice for extirpation of nasopharyngeal malignancies. This study aims to validate the feasibility of endoscopic endonasal resection of lesions with a posterolateral invasion. As a secondary goal, the study intends to propose a classification system of endoscopic endonasal nasopharyngectomy determined by the depth of posterolateral invasion. Eight cadaveric specimens (16 sides) underwent progressive nasopharyngectomy using an endoscopic endonasal approach. Resection of the torus tubarius, Eustachian tube (ET), medial pterygoid plate and muscle, lateral nasal wall, and lateral pterygoid plate and muscle were sequentially performed to expose the fossa of Rosenmüller, petroclival region, parapharyngeal space (PPS), and jugular foramen, respectively. Technical feasibility of endonasal nasopharyngectomy toward a posterolateral direction was validated in all 16 sides. Nasopharyngectomy was classified into four types as follows: (1) type 1: resection restricted to the posterior or superior nasopharynx; (2) type 2: resection includes the torus tubarius which is suitable for lesions extended into the petroclival region; (3) type 3: resection includes the distal cartilaginous ET, medial pterygoid plate, and muscle, often required for lesions extending laterally into the PPS; And (4) type 4: resection includes the lateral nasal wall, pterygoid plates and muscles, and all the cartilaginous ET. This extensive resection is required for lesions involving the carotid artery or extending to the jugular foramen region. Selected lesions with posterolateral invasion into the PPS or jugular foramen is amenable to a resection via expanded endonasal approach. Classification of nasopharyngectomy based on tumor depth of posterolateral invasion helps to plan a surgical approach.
PubMed: 35832961
DOI: 10.1055/s-0041-1735557 -
Folia Medica Cracoviensia 2016The paper describes morphological variants of the jugular foramen of the human skull and discusses the reasons for its frequent asymmetry. Bilateral disproportions...
The paper describes morphological variants of the jugular foramen of the human skull and discusses the reasons for its frequent asymmetry. Bilateral disproportions between the anteroposterior and mediolateral diameters of the jugular foramina were analyzed. We established that the jugular foramen is extremely narrow when its anteroposterior diameter is less than 5.0 mm. When the mediolateral diameter exceeds 20.0 mm, then the foramen exhibits extreme widening.
Topics: Cerebrovascular Circulation; Cranial Nerves; Humans; Jugular Veins; Occipital Bone; Skull Base; Temporal Bone
PubMed: 27513840
DOI: No ID Found -
Journal of Neurological Surgery. Part... Feb 2021Surgical removal of large jugular foramen schwannomas with intra- and extracranial extension is challenging. The treatment goal is a gross total resection of the tumor...
Surgical removal of large jugular foramen schwannomas with intra- and extracranial extension is challenging. The treatment goal is a gross total resection of the tumor without causing surgical complications, including facial nerve paresis, hearing disturbance, dysphagia, hoarseness, and cerebrospinal fluid (CSF) leakage, in addition to the brain stem injury. We present a surgical video in a patient with a dumbbell-shaped glossopharyngeal schwannoma. The combination of posterior fossa craniotomy, mastoidectomy, and unroofing of the jugular foramen with high cervical exposure was selected. Although transposition of the mastoid segment of the facial nerve provides an excellent surgical corridor, it may affect normal facial nerve function. Sufficient drilling of the infralabyrinthine, retrofacial area of the mastoid without facial nerve transposition is important for the safe gross total removal of the tumor. Subcapsular removal behind the jugular vein is also important for preservation of the lower cranial nerve functions. The patient underwent a gross total removal of the tumor ( Figs. 1 and 2 ). Facial nerve function was preserved and hearing disturbance improved. Although dysphagia and hoarseness complicated postoperatively, he became able to take foods orally 16 days after the surgery. In summary, successful removal of a large dumbbell-shaped jugular foramen tumor can be completed via infralabyrinthine, retrofacial, and transjugular approach without facial nerve transposition. The link to the video can be found at: https://youtu.be/U4CwOW78id4 .
PubMed: 33717822
DOI: 10.1055/s-0040-1705167 -
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 -
Cureus Nov 2021Introduction Lesions of the jugular foramen (JF) and postero-lateral skull base are difficult to expose and exhibit complex neurovascular relationships. Given their...
Introduction Lesions of the jugular foramen (JF) and postero-lateral skull base are difficult to expose and exhibit complex neurovascular relationships. Given their rarity and the increasing use of radiosurgery, neurosurgeons are becoming less experienced with their surgical management. Anatomical factors are crucial in designing the approach to achieve a maximal safe resection. Methods and methods Six cadaveric heads (12 sides) were dissected via combined post-auricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. Contiguous surgical triangles were measured, and contents were analyzed. Thirty-one patients (32 lesions) were treated surgically between 2000 and 2016 through different variations of the retro-auricular distal cervical transtemporal approaches. Results We anatomically reviewed the carotid, stylodigastric, jugular, condylar, suboccipital, deep condylar, mastoid, suprajugular, suprahypoglossal (infrajugular), and infrahypoglossal triangles. Tumors included glomus jugulare, lower cranial nerve schwannomas or neurofibromas, meningiomas, chondrosarcoma, adenocystic carcinoma, plasmacytoma of the occipitocervical joint, and a sarcoid lesion. We classified tumors into extracranial, intradural, intraosseous, and dumbbell-shaped, and analyzed the approach selection for each. Conclusion Jugular foramen and posterolateral skull base lesions can be safely resected through a retro-auricular distal cervical lateral skull base approach, which is customizable to anatomical location and tumor extension by tailoring the involved osteo-muscular triangles.
PubMed: 34956763
DOI: 10.7759/cureus.19638