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Journal of Neurological Surgery. Part... Jun 2022Proposed landmarks to predict the anatomical location and trajectory of the sigmoid sinus have varying degrees of reliability. Even with neuronavigation technology,...
Proposed landmarks to predict the anatomical location and trajectory of the sigmoid sinus have varying degrees of reliability. Even with neuronavigation technology, landmarks are crucial in planning and performing complex approaches to the posterolateral skull base. By combining two major dependable structures-the asterion (A) and transverse process of the atlas (TPC1)-we investigate the A-TPC1 line in relation to the sigmoid sinus and in partitioning surgical approaches to the region. We dissected six cadaveric heads (12 sides) to expose the posterolateral skull base, including the mastoid and suboccipital bone, TPC1 and suboccipital triangle, distal jugular vein and internal carotid artery, and lower cranial nerves in the distal cervical region. We inspected the A-TPC1 line before and after drilling the mastoid and occipital bones and studied the relationship of the sigmoid sinus trajectory and major muscular elements related to the line. We retrospectively reviewed 31 head and neck computed tomography (CT) angiograms (62 total sides), excluding posterior fossa or cervical pathologies. Bone and vessels were reconstructed using three-dimensional segmentation software. We measured the distance between the A-TPC1 line and sigmoid sinus at different levels: posterior digastric point (DP), and maximal distances above and below the digastric notch. A-TPC1 length averaged 65 mm and was posterior to the sigmoid sinus in all cadaver specimens, coming closest at the level of the DP. Using the transverse-asterion line as a rostrocaudal division and skull base as a horizontal plane, we divided the major surgical approaches into four quadrants: distal cervical/extreme lateral and jugular foramen (anteroinferior), presigmoid/petrosal (anterosuperior), retrosigmoid/suboccipital (posterosuperior), and far lateral/foramen magnum regions (posteroinferior). Radiographically, the A-TPC1 line was also posterior to the sigmoid sinus in all sides and came closest to the sinus at the level of DP (mean, 7 mm posterior; range, 0-18.7 mm). The maximal distance above the DP had a mean of 10.1 mm (range, 3.6-19.5 mm) and below the DP 5.2 mm (range, 0-20.7 mm). The A-TPC1 line is a helpful landmark reliably found posterior to the sigmoid sinus in cadaveric specimens and radiographic CT scans. It can corroborate the accuracy of neuronavigation, assist in minimizing the risk of sigmoid sinus injury, and is a useful tool in planning surgical approaches to the posterolateral skull base, both preoperatively and intraoperatively.
PubMed: 35832953
DOI: 10.1055/s-0041-1731032 -
AJNR. American Journal of Neuroradiology Jan 2009The purpose of this study was to assess how well the anatomy of the jugular foramen (JF) could be displayed by 3T MR imaging by using a 3D contrast-enhanced fast imaging...
BACKGROUND AND PURPOSE
The purpose of this study was to assess how well the anatomy of the jugular foramen (JF) could be displayed by 3T MR imaging by using a 3D contrast-enhanced fast imaging employing steady-state acquisition sequence (CE-FIESTA) and a 3D contrast-enhanced MR angiographic sequence (CE-MRA).
MATERIALS AND METHODS
Twenty-five patients free of skull base lesions were imaged on a 3T MR imaging scanner using CE-FIESTA and CE-MRA. Two readers analyzed the images in collaboration, with the following objectives: 1) to score the success with which these sequences depicted the glossopharyngeal (CNIX) and vagus (CNX) nerves, their ganglia, and the spinal root of the accessory nerve (spCNXI) within the JF, and 2) to determine the value of anatomic landmarks for the in vivo identification of these structures.
RESULTS
CE-FIESTA and CE-MRA displayed CNIX in 90% and 100% of cases, respectively, CNX in 94% and 100%, and spCNXI in 51% and 0% of cases. The superior ganglion of CNIX was discernible in 89.8% and 87.8%; the inferior ganglion of CNIX, in 73% and 100%; and the superior ganglion of CNX, in 98% and 100% of cases. Landmarks useful for identifying these structures were the inferior petrosal sinus and the external opening of the cochlear aqueduct.
CONCLUSIONS
This study protocol is excellent for displaying the complex anatomy of the JF and related structures. It is expected to aid in detecting small pathologies affecting the JF and in planning the best surgical approach to lesions affecting the JF.
Topics: Contrast Media; Cranial Nerves; Female; Humans; Image Enhancement; Imaging, Three-Dimensional; Jugular Veins; Magnetic Resonance Angiography; Male; Meglumine; Middle Aged; Organometallic Compounds; Skull Base
PubMed: 18832666
DOI: 10.3174/ajnr.A1281 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2019Interest has been renewed in the anatomy and physiology of the carotid sinus nerve (CSN) and its targets (carotid sinus and carotid body, CB), due to recent proposals of... (Review)
Review
Interest has been renewed in the anatomy and physiology of the carotid sinus nerve (CSN) and its targets (carotid sinus and carotid body, CB), due to recent proposals of surgical procedures for a series of common pathologies, such as carotid sinus syndrome, hypertension, heart failure, and insulin resistance. The CSN originates from the glossopharyngeal nerve soon after its appearance from the jugular foramen. It shows frequent communications with the sympathetic trunk (usually at the level of the superior cervical ganglion) and the vagal nerve (main trunk, pharyngeal branches, or superior laryngeal nerve). It courses on the anterior aspect of the internal carotid artery to reach the carotid sinus, CB, and/or intercarotid plexus. In the carotid sinus, type I (dynamic) carotid baroreceptors have larger myelinated A-fibers; type II (tonic) baroreceptors show smaller A- and unmyelinated C-fibers. In the CB, afferent fibers are mainly stimulated by acetylcholine and ATP, released by type I cells. The neurons are located in the petrosal ganglion, and centripetal fibers project on to the solitary tract nucleus: chemosensory inputs to the commissural subnucleus, and baroreceptor inputs to the commissural, medial, dorsomedial, and dorsolateral subnuclei. The baroreceptor component of the CSN elicits sympatho-inhibition and the chemoreceptor component stimulates sympatho-activation. Thus, in refractory hypertension and heart failure (characterized by increased sympathetic activity), baroreceptor electrical stimulation, and CB removal have been proposed. Instead, denervation of the carotid sinus has been proposed for the "carotid sinus syndrome." Anat Rec, 302:575-587, 2019. © 2018 Wiley Periodicals, Inc.
Topics: Carotid Body; Carotid Sinus; Humans
PubMed: 29663677
DOI: 10.1002/ar.23829 -
Acta Otorhinolaryngologica Italica :... Jun 2019
Review
Topics: Adult; Aged; Cohort Studies; Endoscopy; Female; Hearing Loss; Humans; Magnetic Resonance Imaging; Male; Mastoid; Meningeal Neoplasms; Meningioma; Middle Aged; Neuroma, Acoustic; Neurosurgical Procedures; Retrospective Studies; Skull Base; Skull Base Neoplasms; Temporal Bone; Young Adult
PubMed: 31130732
DOI: 10.14639/0392-100X-suppl.1-39-2019 -
Brain Sciences Sep 2022Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild...
Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild tinnitus, headache, and dizziness, together with preoperative related imaging, was diagnosed with a left intra-extracranial communicating jugular foramen lesion in November 2015 and accepted an initial operation for the intracranial tumor by retrosigmoid approach. The pathologic report was paraganglioma. In November 2021, a subtotal resection of the extracranial tumor was conducted for prominent lower cranial nerves (LCNs) deficit and middle ear involvement by infratemporal approach. In patients with IECJFP accompanied by LCNs deficit and middle ear involvement, an initial surgery for extracranial lesion and a second procedure for intracranial tumor were appropriate. However, the first operation for the intracranial lesion was preferred in IECJFP cases without LCNs deficit and middle ear involvement, as it could remove compression to the neurovascular structure and brain stem, clarify a pathological diagnosis, avoid a CSF leak, and prevent a severe neurological disorder from extracranial lesion excision. Subtotal resection of the extracranial tumor would be performed when lesion became larger combined with obvious LCNs disorder and tympanic cavity involvement. Consideration of specific staged surgical strategy for IECJFP in accordance with preoperative LCNs deficit and tympanic cavity involvement could prevent critical postoperative neurological deficit and improve quality of life in the long term.
PubMed: 36138993
DOI: 10.3390/brainsci12091257 -
Brazilian Journal of Otorhinolaryngology 2020The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches...
INTRODUCTION
The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches to the jugular foramen became more frequent, requiring improvement of the knowledge of this region anatomy.
OBJECTIVE
To study the anatomy of the jugular foramen, internal jugular vein and glossopharyngeal, vagus and accessory nerves, and to identify the anatomical relationships among these structures in the jugular foramen region and lateral-pharyngeal space.
METHODS
A total of 60 sides of 30 non-embalmed cadavers were examined few hours after death. The diameters of the jugular foramen and its anatomical relationships were analyzed.
RESULTS
The diameters of the jugular foramen and internal jugular vein were greater on the right side in most studied specimens. The inferior petrosal sinus ended in the internal jugular vein up to 40mm below the jugular foramen; in 5% of cases. The glossopharyngeal nerve exhibited an intimate anatomical relationship with the styloglossus muscle after exiting the skull, and the vagal nerve had a similar relationship with the hypoglossal nerve. The accessory nerve passed around the internal jugular vein via its anterior wall in 71.7% of cadavers.
CONCLUSION
Anatomical variations were found in the dimensions of the jugular foramen and the internal jugular vein, which were larger in size on the right side of most studied bodies; variations also occurred in the trajectory and anatomical relationships of the nerves. The petrosal sinus can join the internal jugular vein below the foramen.
Topics: Accessory Nerve; Adult; Aged; Aged, 80 and over; Anatomic Variation; Dissection; Female; Glossopharyngeal Nerve; Humans; Jugular Foramina; Jugular Veins; Male; Middle Aged; Neck; Vagus Nerve
PubMed: 30348503
DOI: 10.1016/j.bjorl.2018.09.004 -
Turkish Neurosurgery 2020To compare the right and left sides and the endo?exocranial orifices of the jugular foramen (JF) considering the vascular compartment (VC) and the neural compartment...
AIM
To compare the right and left sides and the endo?exocranial orifices of the jugular foramen (JF) considering the vascular compartment (VC) and the neural compartment (NC).
MATERIAL AND METHODS
A total of 20 human dry skulls belonging to the inventory of Medical Faculty, Department of Anatomy, were included in this study. Numerical values were obtained using direct anatomical and also computed tomography measurements.
RESULTS
The endocranial and exocranial VC occupied wider areas on the right side than on the left side (p < 0.05). However, there was no statistically significant difference between the surface area of the endocranial and exocranial NC in terms of the sides (p > 0.05). The length of the endocranial VC was greater on the right than on the left side. The right exocranial VC was wider than the left exocranial VC. However, the widths and lengths of the endocranial and exocranial NC showed no statistically significant difference between the sides (p > 0.05).
CONCLUSION
The right-sided dominance of JF observed in this study was attributed to the length of endocranial VC and the width of exocranial VC.
Topics: Humans; Jugular Foramina; Tomography, X-Ray Computed
PubMed: 32091129
DOI: 10.5137/1019-5149.JTN.26495-19.4 -
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