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La Clinica Terapeutica 2023The present study aimed at determining the incidence of sternal foramina in adult dry bones of North Indian descent. We also aimed to determine the number, precise... (Observational Study)
Observational Study
OBJECTIVES
The present study aimed at determining the incidence of sternal foramina in adult dry bones of North Indian descent. We also aimed to determine the number, precise location of the sternal foramina with a standard reference point which might have considerable importance with regard to procedures involving sternal puncture.
METHODS
This cross sectional descriptive study was conducted on 72 dry adult human sternums. Various measurements in relation to the sternal foramina were taken with a non-stretchable measuring tape and digital vernier calliper and expressed as: [A]-total sternal length, [B]-distance between the jugular notches to the foramen, [C]-distance between the angle of Louis to the foramen and [D]-distance of the foramen from the mid sternal plane. Statistical analysis was performed with Microsoft Excel version 2019. A p-value of <0.05 was considered significant.
RESULTS
We found 6.94% (5 out of 72 sternums) incidence of sternal foramina which corroborates well with the existing literature. Mean sternal length was 127.7 ± 09 mm. The mean distance of the foramina from suprasternal notch, sternal angle and from the median plane were 118.12 ± 0.3 mm, 116.7 mm and 2.4 mm respectively. Incidence of sternal foramina was almost similar to previously reported studies.
CONCLUSIONS
The precise knowledge about the expected location of sternal foramina is imperative to avoid intra-thoracic visceral injury during commonly performed acupuncture needle insertion and while doing bone marrow aspiration for diagnostic evaluation.
Topics: Adult; Humans; Clinical Relevance; Cross-Sectional Studies; Knowledge; Neck; Research Design
PubMed: 38048113
DOI: 10.7417/CT.2023.5017 -
AJNR. American Journal of Neuroradiology Oct 2021Accurate differentiation of paragangliomas and schwannomas in the jugular foramen has important clinical implications because treatment strategies may vary but...
BACKGROUND AND PURPOSE
Accurate differentiation of paragangliomas and schwannomas in the jugular foramen has important clinical implications because treatment strategies may vary but differentiation is not always straightforward with conventional imaging. Our aim was to evaluate the accuracy of both qualitative and quantitative metrics derived from dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel MR imaging to differentiate paragangliomas and schwannomas in the jugular foramen.
MATERIALS AND METHODS
A retrospective study of imaging data was performed on patients ( = 30) undergoing MR imaging for jugular foramen masses with the golden-angle radial sparse parallel MR imaging technique. Imaging data were postprocessed to obtain time-intensity curves and quantitative parameters. Data were normalized to the dural venous sinus for relevant parameters and analyzed for statistical significance using a Student test. A univariate logistic model was created with a binary output, paraganglioma or schwannoma, using a wash-in rate as a variable. Additionally, lesions were clustered on the basis of the wash-in rate and washout rate using a 3-nearest neighbors method.
RESULTS
There were 22 paragangliomas and 8 schwannomas. All paragangliomas demonstrated a type 3 time-intensity curve, and all schwannomas demonstrated a type 1 time-intensity curve. There was a statistically significant difference between paragangliomas and schwannomas when comparing their values for area under the curve, peak enhancement, wash-in rate, and washout rate. A univariate logistic model with a binary output (paraganglioma or schwannoma) using wash-in rate as a variable was able to correctly predict all observed lesions ( < .001). All 30 lesions were classified correctly by using a 3-nearest neighbors method.
CONCLUSIONS
Paragangliomas at the jugular foramen can be reliably differentiated from schwannomas using golden-angle radial sparse parallel MR imaging-dynamic contrast-enhanced imaging when imaging characteristics cannot suffice.
Topics: Contrast Media; Humans; Jugular Foramina; Magnetic Resonance Imaging; Neurilemmoma; Paraganglioma; Retrospective Studies
PubMed: 34503944
DOI: 10.3174/ajnr.A7243 -
Arquivos de Neuro-psiquiatria Sep 2014To compare the right and left sides of the same skulls as far as the described landmarks are concerned, and establish the craniometric differences between them. (Comparative Study)
Comparative Study
OBJECTIVE
To compare the right and left sides of the same skulls as far as the described landmarks are concerned, and establish the craniometric differences between them.
METHOD
We carried out measurements in 50 adult dry human skulls comparing both sides.
RESULTS
The sigmoid sinus width at the sinodural angle level was larger on the right side in 78% of the cases and at the level of the digastric notch in 72%. The jugular foramen width was also larger on the right side in 84% of the cases. The sigmoid sinus distance at the level of the digastric notch was larger on the right side in 64% of the cases, and the sigmoid sinus distance at the level of the digastric notch to the jugular foramen was larger on the right side in 70% of the cases.
CONCLUSION
Significant craniometric differences were found between both sides of the same skulls.
Topics: Adult; Anatomic Landmarks; Cephalometry; Cranial Sinuses; Humans; Lasers; Occipital Bone; Reference Values; Skull Base; Transillumination
PubMed: 25252233
DOI: 10.1590/0004-282x20140117 -
Heliyon Jan 2020Perivascular epithelioid cell tumors (PEComas) of the skull base are extremely rare. Here we report the first description of a malignant PEComa mimicking jugular foramen...
BACKGROUND
Perivascular epithelioid cell tumors (PEComas) of the skull base are extremely rare. Here we report the first description of a malignant PEComa mimicking jugular foramen schwannoma and presenting as Collet-Sicard syndrome, and we review the previous literature on PEComas of the head, neck and skull base.
CASE DESCRIPTION
A 29-year-old woman presented with hoarseness, dysphagia, vomiting, and headache. She was first diagnosed with Collet-Sicard syndrome caused by thrombosis of the sigmoid and transverse sinuses. She was treated with anticoagulant therapy, and the hoarseness and paralysis of the accessory nerve improved. Later, at age 31, the hoarseness again worsened. At another hospital, enhanced computed tomography revealed a tumor in the jugular foramen extending to the neck and medially displacing the internal carotid artery. She was referred to our hospital for further examination and was diagnosed with jugular foramen schwannoma causing thrombosis of the sinuses. At the one-year follow-up, the tumor had grown rapidly and had started to surround the internal carotid artery. We therefore performed a tissue biopsy of the tumor in the jugular foramen and neck. Based on pathological analysis, we made a definitive diagnosis of malignant PEComa.
CONCLUSIONS
It may be extremely challenging to reach an accurate diagnosis of PEComa in the skull-base region, which can cause a delay in treatment initiation. When atypical clinical features for a skull-base tumor are found, we recommend preliminary biopsy to obtain a definitive diagnosis and initiate an appropriate treatment strategy as early as possible.
PubMed: 32042962
DOI: 10.1016/j.heliyon.2020.e03200 -
Journal of Craniovertebral Junction &... 2016The transcondylar approach (TCA) has gained importance in recent era which enables shorter and direct route to access the lesions ventral to the brainstem. The important...
BACKGROUND
The transcondylar approach (TCA) has gained importance in recent era which enables shorter and direct route to access the lesions ventral to the brainstem. The important step in this approach is resection of the occipital condyle (OC). The detailed knowledge of bony anatomy of OC and its relation to the hypoglossal canal (HC), condylar canal (CC), and jugular foramen (JF) is very important to avoid any iatrogenic injury during craniovertebral surgeries. The aim of the present study is to conduct a morphometric and morphological study and note the variations of the OC and the structures surrounding it in North Indian population.
MATERIALS AND METHODS
The study was carried out on 100 OC. Morphometric measurements of OC and the distances of HC and JF from the posterior end of OC were noted. In addition, the extent of the HC and JF in relation to OC, presence or absence of CC, shape of the OC, and its articular facet were also noted.
RESULTS
The incidence of short OC was seen in 13% skulls. The most common shape of OC was oval or rhomboid. Even though the articular facet was convex in majority of skulls but flat (10%) and concave (1%) were also observed. The external and internal distance of HC from the posterior end of OC was13.83 mm and 10.66 mm on the right side and 15.02 mm and 11.89 mm on the left side. The OC was related in its middle 1/3 to the HC in 15% skulls and to the whole extent of JF in 3% skulls. Thirty-four percent skulls displayed the septa in the HC. The CC was present bilaterally in 38% skulls and unilaterally in 40% skulls.
CONCLUSION
The OC and related structures such as HC, CC, and JF are likely to have variations in respect to morphometry and morphology. This study may prove helpful to neurosurgeons operating in this field, especially during TCA where neurovascular structures emerging from these canals and foramen are more vulnerable to injury.
PubMed: 27891034
DOI: 10.4103/0974-8237.193258 -
Arquivos de Neuro-psiquiatria Dec 2004Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil,...
Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and 2001. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.
Topics: Adolescent; Adult; Cranial Nerve Neoplasms; Craniotomy; Facial Nerve; Female; Glomus Jugulare; Glomus Jugulare Tumor; Humans; Male; Mastoid; Middle Aged; Temporal Bone; Treatment Outcome
PubMed: 15608958
DOI: 10.1590/s0004-282x2004000600012 -
Journal of Neurosurgery. Case Lessons Aug 2021Paragangliomas (PGLs) are rare neoplasms that may be associated with hereditary PGL syndromes and variable risk of metastasis. Middle ear adenomas are extremely rare...
Clinical and histopathological principles for the diagnosis of a recurrent paraganglioma of the jugular foramen initially diagnosed as a middle ear adenoma: illustrative case.
BACKGROUND
Paragangliomas (PGLs) are rare neoplasms that may be associated with hereditary PGL syndromes and variable risk of metastasis. Middle ear adenomas are extremely rare tumors with no known hereditary predisposition and extremely low risk of metastasis. Although often easily differentiated, they may share clinical and pathological features that misdirect and confuse the diagnosis.
OBSERVATIONS
The authors discussed a 35-year-old woman with left-sided hearing loss and bleeding from the external ear canal who presented to an outside hospital. She underwent resection of a middle ear and mastoid mass, initially diagnosed as a middle ear adenoma with neuroendocrine features, with later mastoidectomy and ligation of the sigmoid sinus with microsurgical excision of persistent tumor in the jugular foramen and temporal bone. Histopathologically, her tumor was vascular, composed of benign-appearing epithelioid cells with "salt and pepper" neuroendocrine chromatin arranged in vague nests. Lesional cells were GATA3-immunopositive, glucagon-negative, and succinate dehydrogenase-immunonegative, consistent with PGL rather than middle ear adenoma, and required further workup for hereditary PGL syndromes.
LESSONS
This case demonstrates potential challenges in differentiating a PGL from a middle ear adenoma. The authors offer clinical, histopathological, and imaging principles to aid in diagnosis and workup.
PubMed: 36131578
DOI: 10.3171/CASE21307 -
The Cochrane Database of Systematic... May 2013Malignant, or necrotising, otitis externa is a potentially fatal infection of the external ear canal and surrounding soft tissue and bone. It may be complicated by... (Review)
Review
BACKGROUND
Malignant, or necrotising, otitis externa is a potentially fatal infection of the external ear canal and surrounding soft tissue and bone. It may be complicated by involvement of cranial nerves, principally the facial nerves and the contents of the jugular foramen. It is an uncommon condition mainly found in the elderly or in diabetics.
OBJECTIVES
To assess the effectiveness of adjunctive hyperbaric oxygen treatment for malignant otitis externa.
SEARCH METHODS
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 4 April 2013.
SELECTION CRITERIA
Randomised controlled trials, involving adults, undergoing hyperbaric oxygen therapy in malignant otitis externa.
DATA COLLECTION AND ANALYSIS
No identified articles described randomised controlled trials of hyperbaric oxygen therapy in the treatment of malignant otitis externa.
MAIN RESULTS
Due to the lack of data we could present no results.
AUTHORS' CONCLUSIONS
No clear evidence exists to demonstrate the efficacy of hyperbaric oxygen therapy when compared to treatment with antibiotics and/or surgery. We found no data to compare rates of complication between the different treatment modalities. Further research is required.
Topics: Bacterial Infections; Humans; Hyperbaric Oxygenation; Necrosis; Otitis Externa
PubMed: 23728650
DOI: 10.1002/14651858.CD004617.pub3 -
Surgical and Radiologic Anatomy : SRA May 2023Anatomical knowledge of the hypoglossal canal is very important in relation to drilling of occipital condyle, jugular tubercle etc. So, this study was conducted to...
PURPOSE
Anatomical knowledge of the hypoglossal canal is very important in relation to drilling of occipital condyle, jugular tubercle etc. So, this study was conducted to identify various morphometric and morphological features of the hypoglossal canal and its distance from adjacent structures relative to stable and reliable anatomic landmarks.
METHODS
The study was performed on 142 hypoglossal canals of 71 adult human dry skulls. The parameters measured were the transverse, vertical diameter, depth of the hypoglossal canal. The distances from the hypoglossal canal to the foramen magnum, occipital condyle and jugular foramen were also noted. In addition, the different locations of the hypoglossal canal orifices in relation to the occipital condyle were assessed. The different shapes and types of the hypoglossal canal were also noted.
RESULTS
There was significant difference (p < 0.05) in measurements taken on the right and left sides in males and females. The intracranial orifice of hypoglossal canal was present in middle 1/3rd in 100% of occipital condyle for both genders. The extracranial orifice of the hypoglossal canal was found to be in the anterior 1/3rd in 99% and 93.7% for male and female, respectively. Simple hypoglossal canal with no traces of partition was found to be more in males and females. The most common shape noted was oval both in males and females (71.8% and 68.7% respectively).
CONCLUSION
The results of the dimensions of the hypoglossal canal and its distance from other bony landmarks will be helpful for neurosurgeons to plan which surgical approaches should be undertaken while doing various surgeries in posterior cranial fossa.
Topics: Adult; Female; Male; Humans; Occipital Bone; Foramen Magnum; Skull; Neurosurgical Procedures; Cranial Fossa, Posterior; Orthopedic Procedures; Skull Base
PubMed: 36930271
DOI: 10.1007/s00276-023-03126-7 -
Skull Base Surgery 1999Meningiomas involving the temporal bone may originate from arachnoid cell nests present within the temporal bone (intratemporal), but more frequently originate from...
Meningiomas involving the temporal bone may originate from arachnoid cell nests present within the temporal bone (intratemporal), but more frequently originate from arachnoid cell nests of the posterior or middle cranial fossa with secondary invasion of the TB (extratemporal). In this study, we retrospectively reviewed the charts of 13 patients with meningiomas involving the temporal bone who underwent surgery. Tumors of the posterior fossa with only temporal bone hyperostosis, but without invasion, were excluded. Patients presented primarily with otologic symptoms and signs. The tumors originated in the temporal bone (5/13), jugular foramen (4/13), petroclival region (2/13), the asterion (1/13) or the internal auditory meatus (1/13). All of the intratemporal meningiomas had the radiological appearance of en-plaque menigiomas. The tumor extended into the middle ear (11/13), eustachian tube (5/13), and/or the labyrinth (3/13). A gross total resection was achieved in 11 patients and a subtotal resection in 2 patients. The lower cranial nerves were infiltrated by tumor in 4 patients, and were sacrificed. At a mean follow-up of approximately 6 years, 12 patients are currently alive and doing well and 1 died from tumor progression. Six patients showed tumor recurrence and were reoperated on (5/6) or followed conservatively (1/6). Surgical treatment of temporal bone meningiomas is associated with high recurrence rate due to indiscreet tumor margins. Combined surgical approaches (temporal craniotomy and mastoidectomy) by neurosurgical and otological teams are recommended for meningiomas originating in the temporal bone.
PubMed: 17171128
DOI: 10.1055/s-2008-1058159