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The Neuroradiology Journal Apr 2023Asymmetry between the transverse sinuses (TS) is quite common. We sought to test the possible hypothesis that certain anatomical features - namely, occipital lobe...
BACKGROUND
Asymmetry between the transverse sinuses (TS) is quite common. We sought to test the possible hypothesis that certain anatomical features - namely, occipital lobe bending, Gibraltar sign of superior sagittal sinus groove (SSS) and jugular foramen (JF) dimensions - can predict dominance of the transverse sinuses on routine axial T1- and T2-weighted images.
MATERIALS AND METHODS
One hundred consecutively acquired combined MRI-MRV studies of brain were reviewed. On non-contrast axial T1WI, each reviewer assessed the occipital lobe bending, and Gibraltar sign of SSS groove; on axial T2-weighted images, JF dimensions were measured. TS cross-sectional area was measured on non-contrast sagittal 2-dimensional phase contrast MRV images and served as the reference standard.
RESULTS
Of the 51 subjects with right-dominant TS, 37 had occipital bending to the right side and 35 showed sloping of the Gibraltar sign to right side. Of the 18 subjects with left dominant TS, 10 had occipital bending to left side and 13 showed left-sided sloping of the Gibraltar sign. Of the 31 subjects with co-dominant TS, 15 had no occipital bending and 20 showed no sloping of the Gibraltar sign. Mean right and left JF dimensions were higher in the right and left dominant TS respectively with no significant differences in patients with co-dominant sinus ( < 0.02).
CONCLUSION
Right occipital bending had a good association with right TS dominance. The other two parameters- Gibraltar sign of superior sagittal sinus groove and jugular foramen dimensions - did not have a very good association with respect to TS dominance.
Topics: Humans; Transverse Sinuses; Superior Sagittal Sinus; Gibraltar; Jugular Foramina; Occipital Lobe; Cranial Sinuses
PubMed: 35727589
DOI: 10.1177/19714009221111086 -
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 -
CNS Neuroscience & Therapeutics Nov 2022Differentiating between acquired stenosis (pathologic) and anatomical slenderness (physiologic) of internal jugular vein (IJV) remain ambiguous. Herein, we aimed to...
BACKGROUND AND PURPOSES
Differentiating between acquired stenosis (pathologic) and anatomical slenderness (physiologic) of internal jugular vein (IJV) remain ambiguous. Herein, we aimed to compare the similarities and differences between the two entities.
METHODS
Patients who underwent head and neck computer tomography (CT) and brain magnetic resonance imaging (MRI) were enrolled in this case-control study from January 2016 through October 2021.
RESULTS
1487 eligible patients entered final analysis totally. 803 patients had bilateral IJVs imaging without IJV stenosis-related symptoms and presented in three ways: right IJV slenderness (10.5%, n = 85), left IJV slenderness (48.4%, n = 388), and symmetric IJVs (41.1%, n = 330). In patients with asymmetric IJVs, their bilateral jugular foramina were also asymmetric. All involved asymmetric IJVs presented as slenderness without surrounding abnormal collaterals and credible cloudy-like white matter hyper-intensity (WMH). Their cerebral arterial perfusion statuses on brain MR-PWI maps were normal. In contrast, the major patients with IJV stenosis presented with signs and symptoms such as headaches, head noise, etc. In CE-MRV maps, local stenosis of the IJV was surrounded by abnormal venous collaterals in contrast to the lack of abnormal venous collaterals for patients with IJV slenderness. And in CTV maps, the caliber of jugular foramina was mismatched with the transverse diameter of IJV. Moreover, in MRI maps of most of these patients, a cloudy-like WMHs were distributed symmetrically in bilateral periventricular and/or centrum semi vales. These patients also had symmetrical cerebral arterial hypo-perfusion. Seven patients underwent stenting of the IJV stenosis correction, their WMHs attenuated or disappeared subsequently.
CONCLUSIONS
Imaging features in addition to clinical symptoms can be used to differentiate between physiologic IJV slenderness and pathologic IJV stenosis. Notable imagine-defining features for IJV stenosis include local stenosis surrounded by abnormal venous collaterals, cloudy-like WMHs, and mismatch between the transverse diameter of IJV and the caliber of the jugular foramina.
Topics: Case-Control Studies; Constriction, Pathologic; Humans; Jugular Veins; Magnetic Resonance Imaging; Neck
PubMed: 35919952
DOI: 10.1111/cns.13924 -
AJNR. American Journal of Neuroradiology Jan 2003Complex and syndromic craniosynostosis can be complicated by raised intracranial pressure (ICP), which in the absence of other identifiable origins, is probably caused...
BACKGROUND AND PURPOSE
Complex and syndromic craniosynostosis can be complicated by raised intracranial pressure (ICP), which in the absence of other identifiable origins, is probably caused by venous hypertension. Children with these conditions have been shown to have narrowing of the sigmoid sinus-jugular vein complex. Evidence of bony narrowing of the jugular foramina in children with complex or syndromic craniosynostosis and raised ICP compared with that in children with craniosynostosis without raised ICP would provide support for the theory that venous hypertension occurs in the former children.
METHODS
Measurements of the jugular foramina were obtained from reformatted helical CT scans obtained in 12 children with complex or syndromic craniosynostosis and raised ICP (group 1) and in two control groups of children with normal ICP. The first control group comprised 10 children with simple nonsyndromic synostosis of one or two sutures (group 2), and the second control group included nine children with complex or syndromic craniosynostosis (group 3).
RESULTS
Children with raised ICP had narrower jugular foramina than did the age-matched control subjects. For group 1, the mean diameter of jugular foramina was 6.5 mm; group 2, 11.5 mm (P <.01); and group 3, 10 mm (P <.05). No significant difference existed between the two control groups.
CONCLUSION
Significantly narrower jugular foramina in children with raised ICP is further evidence of the role of venous outflow obstruction and intracranial venous hypertension in the development of raised ICP in complex and syndromic craniosynostosis.
Topics: Child; Child, Preschool; Constriction, Pathologic; Cranial Sinuses; Craniosynostoses; Female; Humans; Image Processing, Computer-Assisted; Infant; Intracranial Pressure; Jugular Veins; Male; Syndrome; Tomography, Spiral Computed; Venous Pressure
PubMed: 12533326
DOI: No ID Found -
Case Reports in Otolaryngology 2020Bilateral jugular foramen stenosis with jugular bulb and vein aplasia is rare in nonsyndromic craniosynostosis and usually diagnosed during childhood. We present a case...
Bilateral jugular foramen stenosis with jugular bulb and vein aplasia is rare in nonsyndromic craniosynostosis and usually diagnosed during childhood. We present a case of bilateral jugular foramen stenosis with jugular bulb and vein aplasia, with subsequent persistence and enlargement of the fetal venous anastomosis in the middle and posterior cranial fossa, along with a review of the literature about this anatomical abnormality, highlighting the surgical challenges and management from the otologist/neurotologist point of view.
PubMed: 32566343
DOI: 10.1155/2020/1530310 -
Turkish Neurosurgery 2011The foramen magnum (FM) is a unique and complex anatomical region. The occipital condyle (OC) and jugular tubercle (JT) are the main bony structures which obscure the...
AIM
The foramen magnum (FM) is a unique and complex anatomical region. The occipital condyle (OC) and jugular tubercle (JT) are the main bony structures which obscure the anterolaterally situated lesions of the FM.The aim of this study was to revisit the anatomy of the FM region and assess variations of the surrounding structures.
MATERIAL AND METHODS
Observations, on thirty dry skulls (dried specimens, 60 sides) and ten formalin-fixed cadaveric heads with perfused vessels, were carried out to define the microsurgical anatomy of the FM region. Morphometric analysis and variations of the FM, OC, JT and hypoglossal canal (HC) were noted. Radiological assessment (3D-computed tomography) of the OC, JT, HC were also conducted on dry skulls.
RESULTS
The short and long OC were demonstrated in 5% and 33% of the specimens, respectively. Flat formation of the JT was determined in 10% and tall JT was found in 23% of the specimens. The comparison of the anatomical measurements and the correspondent radiological mean values did not achieve statistical significance.
CONCLUSION
The OC and JT are the main bony prominences obstructing the anterolateral surface of the brainstem. Neurosurgeons should be familiar with variations of the structures surrounding the FM in order to perform the safest and widest exposure possible.
Topics: Adult; Aged; Atlanto-Occipital Joint; Cadaver; Dissection; Female; Foramen Magnum; Humans; Imaging, Three-Dimensional; Jugular Veins; Male; Middle Aged; Occipital Bone; Skull Base; Tomography, X-Ray Computed; Young Adult
PubMed: 21534200
DOI: 10.5137/1019-5149.JTN.3838-10.1 -
Skull Base : Official Journal of North... Jan 2009
PubMed: 19568337
DOI: 10.1055/s-0028-1124015 -
The Neurohospitalist Jul 2023Jugular foramen syndrome (JFS) is a lower cranial neuropathy syndrome characterized by dysphonia and dysphagia. The syndrome is caused by dysfunction of the...
Jugular foramen syndrome (JFS) is a lower cranial neuropathy syndrome characterized by dysphonia and dysphagia. The syndrome is caused by dysfunction of the glossopharyngeal, vagus, and spinal accessory nerves at the level of the pars nervosa and pars vascularis within the jugular foramen. There are numerous etiologies for JFS, including malignancy, trauma, vascular, and infection. Here, we present the case of a healthy adult man who developed JFS secondary to an atypical presentation of Varicella Zoster meningitis, and was promptly diagnosed and treated with rapid symptom resolution. We diagnosed the patient using specialized skull-based imaging which detailed the jugular foramen, as well as CSF analysis. This case highlights the clinical value of detailed structural evaluation, consideration for infection in the absence of systemic symptoms, and favorable outcomes following early identification and treatment.
PubMed: 37441204
DOI: 10.1177/19418744221116717 -
Journal of Neurological Surgery. Part... Jun 2019Despite being pathologically benign, jugular foramen meningioma (JFM) may be locally aggressive and spread in three compartments. Because of the complex anatomical...
Despite being pathologically benign, jugular foramen meningioma (JFM) may be locally aggressive and spread in three compartments. Because of the complex anatomical location, radical removal of JFM usually causes serious morbidity through lower cranial nerve (LCN) deficits. To accomplish long-standing tumor control with good functional outcomes, we report function-preserving multimodal treatment (FMT) for JFM, comprising the combination of intradural tumor removal with the preservation of LCN function and stereotactic radiosurgery (RS) for the residual tumor. This study investigated six JFM patients (five women, one man). Preoperatively, five patients showed no LCN sign. All patients underwent function-preserving retrosigmoid intradural tumor removal, and no patient developed new LCN deficit. Three patients underwent RS for the residual tumor at 8 to 12 months after surgery. After RS, all three tumors were controlled. No patients showed tumor recurrence or new LCN deficits in the follow-up period (2 months to 8 years). FMT for JFMs can accomplish long-standing tumor control with excellent functional outcomes.
PubMed: 31143565
DOI: 10.1055/s-0038-1668137 -
Skull Base Surgery 1999Twelve cases of schwannomas of the jugular foramen that involved surgery in our department between 1983 and 1997 are described. Eight were women and 4 were men (mean...
Twelve cases of schwannomas of the jugular foramen that involved surgery in our department between 1983 and 1997 are described. Eight were women and 4 were men (mean age, 40 years), and the duration of their symptoms, the most predominant of which were hearing loss and tinnitus, ranged from 1 month to 20 years (median, 8.5 months). Depending on their radiological and surgical features, tumors were classified as type A, a tumor primarily at the cerebellopontine angle with minimal enlargement of the jugular foramen (n = 5); type B, a tumor primarily at the jugular foramen with or without intracranial extension (n = 4); type C, a primarily extracranial tumor with extension into the jugular foramen (n = 0); or type D, a dumbbell tumor with both intracranial and extracranial components (n = 3). A retrosigmoid suboccipital craniectomy (RSSOC) was performed for type A tumors; for types B and D, the RSSOC or staged infratemporal fossa approach (ITFA)/RSSOC was used. Total removal was achieved in 6 cases, near total removal in 3, and subtotal removal in 3. The most common complication was lower cranial nerve dysfunction (n = 5). The follow-up period ranged from 6 to 173 (mean, 48) months, and there was no recurrence. Two patients showed regrowth of the tumor after subtotal resection, however. In 1 of these, the residual tumor had progressed within 12 months of initial surgery, it was again resected and linac radiosurgery was successful. In the other, the residual mass had progressed within 8 months of initial surgery, and the pathological report indicated malignant peripheral nerve sheath tumor. Conclusively, type A tumors could be totally resected with the retrosigmoid approach alone. For type B and D tumors, however, combined ITFA and retrosigmoid approach showed the better results. In spite of our limited data, cases showing adhesion to critical structures can be managed by subtotal or near total resection followed by radiosurgery to reduce postoperative complications.
PubMed: 17171112
DOI: 10.1055/s-2008-1058133