Imaging of the Petrous Apex, Cerebellopontine Angles and Jugular Foramen

2021 ◽  
pp. 135-148
Author(s):  
Dinesh Singh
Keyword(s):  
Jugular Foramen ◽  
Petrous Apex

Epidermoid Cysts and Cholesterol Granulomas Centered on the Posterior Fossa: Twenty Years of Diagnosis and Management

Neurosurgery ◽  
1987 ◽  
Vol 21 (6) ◽  
pp. 798-805 ◽  
Author(s):  
Howard Ian Sabin ◽  
Lorenzo Tommaso Bordi ◽  
Lindsay Symon
Keyword(s):  
Posterior Fossa ◽  
Diagnostic Procedures ◽  
Jugular Foramen ◽  
Neurological Deficits ◽  
Petrous Apex ◽  
Epidermoid Cysts ◽  
Diagnosis And Management ◽  
Presenting Symptoms ◽  
Review Period ◽  
Contrast Ventriculography

Abstract The clinical features, diagnosis, and management of 23 posterior fossa epidermoid cysts and 9 petrous apex lesions presenting to one unit over a period of 20 years are summarized. Of the epidermoid cysts, 13 were entirely infratentorial, but the other 10 had an additional supratentorial component. Presenting symptoms and signs were usually long-standing and at onset had often been vague and nonspecific. With time, however, a variety of neurological deficits that depended on the site of the lesion developed. These were generally combinations of cerebellopontine (CP) angle and jugular foramen syndromes, deafness, facial palsy, and motor weakness. Diagnostic procedures have changed greatly over the review period. Computed tomography and magnetic resonance imaging have replaced air encephalography and contrast ventriculography. The better preoperative localization of these lesions allows rational planning of the surgical approach required for optimal tumor exposure, which is essential for any attempt at total excision, considering the large size of the majority of these tumors when diagnosed. We favor operation through a posterior fossa craniectomy for those tumors restricted to the CP angle or 4th ventricle, but routinely use a combined supra- and infratentorial approach if the lesion has a more rostral component. The infiltrating nature of epidermoid cysts within the cranium compromises the extent of excision if neurological deficit is not to be increased, but we attempt as complete an excision of tumor and capsule as possible in the hope that many years will pass before symptoms recur. Cholesterol granulomas seem to respond well to simple cavity drainage and have shown no tendency to recur.

scholarly journals Outcomes of Facial Nerve in Lateral and Inferior Mastoid Approaches for Jugular Foramen and Petrous Apex Lesions

2018 ◽  
Vol 07 (01) ◽  
pp. 023-028
Author(s):  
Saurin Shah ◽  
Amit Keshri ◽  
Simple Patadia ◽  
Rabi Sahu ◽  
Raj Kumar
Keyword(s):  
Facial Nerve ◽  
Tertiary Care ◽  
Tumor Resection ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Outcomes Measures ◽  
Extent Of Disease ◽  
Satisfactory Recovery

Abstract Objectives To evaluate the facial nerve in inferior and lateral (transmastoid) approaches to the jugular foramen and/or petrous apex. Design Retrospective study of 11 consecutive patients operated for lesions in the jugular foramen/petrous apex via an inferior or lateral transpetrosal approach. Setting Tertiary care superspecialty referral center. Participants Eleven consecutive patients of jugular foramen/petrous apex lesions operated over a period of 18 months. Main Outcomes Measures Extent of tumor resection, surgical technique used, and recovery of facial nerve function postoperatively. Conclusion Approach to these lesions needs to be tailored to the extent of disease, possible histology and relation to the facial nerve. Meticulous surgery and adequate postoperative care permit a satisfactory recovery of facial nerve function following rerouting procedures.

scholarly journals Endoscopic endonasal translacerum approach to the inferior petrous apex

2016 ◽  
Vol 124 (4) ◽  
pp. 1032-1038 ◽  
Author(s):  
Masaaki Taniguchi ◽  
Nobuyuki Akutsu ◽  
Katsu Mizukawa ◽  
Masaaki Kohta ◽  
Hidehito Kimura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Surgical Simulation ◽  
Internal Auditory Canal ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Partial Removal ◽  
Endoscopic Endonasal ◽  
Anatomical Features ◽  
Petrous Portion ◽  
Sufficient Space

OBJECT The surgical approach to lesions involving the inferior petrous apex (IPA) is still challenging. The purpose of this study is to demonstrate the anatomical features of the IPA and to assess the applicability of an endoscopic endonasal approach through the foramen lacerum (translacerum approach) to the IPA. METHODS The surgical simulation of the endoscopic endonasal translacerum approach was conducted in 3 cadaver heads. The same technique was applied in 4 patients harboring tumors involving the IPA (3 chordomas and 1 chondro-sarcoma). RESULTS By removing the fibrocartilaginous component of the foramen lacerum, a triangular space was created between the anterior genu of the petrous portion of the carotid artery and the eustachian tube, through which the IPA could be approached. The range of the surgical maneuver reached laterally up to the internal auditory canal, jugular foramen, and posterior vertical segment of the petrous portion of the carotid artery. In clinical application, the translacerum approach provided sufficient space to handle tumors at the IPA. Gross-total and partial removal was achieved in 3 and 1 cases, respectively, without permanent surgery-related morbidity and mortality. CONCLUSIONS The endoscopic endonasal translacerum approach provides reliable access to the IPA. It is indicated alone for lesions confined to the IPA and in combination with other approaches for more extensive lesions.

Anterior inferior petrosectomy: defining the role of endonasal endoscopic techniques for petrous apex approaches

2014 ◽  
Vol 120 (6) ◽  
pp. 1321-1325 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Puya Alikhani ◽  
Mark H. Tabor ◽  
Harry R. van Loveren ◽  
Sivero Agazzi ◽  
...  
Keyword(s):  
3D Modeling ◽  
Jugular Foramen ◽  
Contralateral Side ◽  
Petrous Apex ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
Inferior Portion ◽  
Anterior Petrosectomy ◽  
Superior Portion

Object Historically, surgery to the petrous apex has been addressed via craniotomy and open microscopic anterior petrosectomy (OAP). However, with the popularization of endoscopic approaches, the petrous apex can further be approached endonasally by way of an endoscopic endonasal anterior petrosectomy (EAP). Endonasal anterior petrosectomy is a relatively new procedure and has not been compared anatomically with OAP. The authors hypothesized that the EAP and OAP techniques approach different portions of the petrous apex and therefore may have different applications. Methods Four cadaveric heads were used. An OAP was performed on one side and an EAP was performed on the contralateral side; the limits of bony resection were defined. The extent of bony resection was then evaluated using predissection and postdissection thin-slice CT scans. The comparative resection was then reconstructed using 3D modeling on Brainlab workstations. Results The average resection volumes for EAP and OAP were 0.297 cm3 and 0.649 cm3, respectively, representing a comparative percentage of 46% (EAP/OAP). An EAP and OAP achieved resection of 29% and 64% of the total petrous apex volume, respectively. Indeed, EAP addressed the inferior portion of the petrous apex located adjacent to the petroclival suture more completely than OAP, where 45% of the bone overlying the petroclival suture (petroclival angle to the jugular foramen) was resected with the EAP, while 0% was resected with the OAP. Conclusions In anatomically normal cadavers, OAP achieved nearly a 50% larger volumetric resection than EAP. Furthermore, while OAP appears to completely address the superior portion of the petrous apex, EAP appears to have a niche in approaches to lesions in the inferior petrous apex. Given these results, the authors propose that OAP be redefined as the “superior anterior petrosectomy,” while EAP be referred to as the “inferior anterior petrosectomy,” which more clearly defines the role of each approach in anterior petrosectomy.

scholarly journals Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

2020 ◽  
pp. 86-94
Author(s):  
K. M. Diab ◽  
O. S. Panina ◽  
O. A. Pashchinina
Keyword(s):  
Temporal Bone ◽  
Surgical Approach ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Occipital Condyle ◽  
Epidermal Cyst ◽  
Scientific Center

Introduction. Petrous temporal bone (PTB) cholesteatoma is an epidermal cyst, which is the result of uncontrolled growth of keratinizing squamous epithelium in the petrous part of the temporal bone. Cholesteatoma is classified into congenital, acquired, and iatrogenic.Objective. To discuss the classification of infralabyrinthine petrous bone cholesteatoma (PBC), add modified classificationand to propose adequate differential surgical management.Methods. The setting was a National Medical Scientific Center of Otorhinolaryngology FMBA (Russia). The data of 14 patients who underwent surgery for different variations of infralabyrinthine PBC from 2017 till 2020 were analyzed and included into the study (with respect to localization type of the approach used, complications, recurrences and outcome). The follow-up period ranged from 6 to 34 months with a median of 18 months.Results. Based on preoperative CT scans and intraoperative findings a Scale of Cholesteatoma extension CLIF(APO) and Modified classification of infralabyrinthine cholesteatoma (in relation to mastoid segment of the facial nerve) are proposed. The scale includes the main anatomical structures of the temporal bone and the adjacent parts of the occipital and sphenoid bones, which may be involved in the cholesteatoma process: cochlea, vestibule and semicircular canals, internal auditory canal, jugular foramen, bony chanal of the internal carotid artery, petrous apex, occipital condyle. Based on the modified classification and scale we present an algorithm for decision making and surgical approach choosing.Conclusion. The implementation of the Scale of Cholesteatoma Extension in Otology and Radiology practice will allow to preoperatively diagnose the extension of PBC, unify the data of the localization of cholesteatoma; allows standardization in reporting and continuity at all stages of treatment. The modified classification proposed by us in this article facilitate the algorithm for selecting the type of surgical approach and determine whether to perform less aggressive combined microscopic approaches with endoscopic control.

The investigation and management of petrous apex ersion

1985 ◽  
Vol 99 (5) ◽  
pp. 439-450 ◽  
Author(s):  
L. M. Flood ◽  
J. L. Kemink ◽  
M. D. Graham
Keyword(s):  
Temporal Bone ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Unique Challenge ◽  
Anterior Extension ◽  
Facial Numbness ◽  
Lower Cranial Nerves ◽  
Ear Effusion

AbstractDisease of the apex of the petrous temporal bone, while rarely encountered, can present a unique challenge to the otologist. Lesions tend to be advanced at presentation, as massive bony erosion can remain asymptomatic. When symptoms occur, they reflect involvement of the neurovascular contents of the temporal bone. The earliest clinical features, such as headache, facial numbness and middle-ear effusion, do not immediately suggest the site or gravity of the underlying pathology. Anterior extension of disease may produce ophthalmoplegia and diplopia whilst posterior spread involves the lower cranial nerves, within the internal auditory canal, jugular foramen and hypoglossal canal.

scholarly journals Vernet syndrome: intracranial extension of a slow-growing mass

2019 ◽  
Vol 12 (5) ◽  
pp. e228039 ◽  
Author(s):  
Francisco Monteiro ◽  
Pedro Oliveira ◽  
José Peneda ◽  
Artur Condé
Keyword(s):  
Head And Neck ◽  
Cranial Nerves ◽  
Signs And Symptoms ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Intracranial Extension ◽  
Rare Clinical Entity ◽  
Neck Trauma ◽  
Slow Growing ◽  
Growing Mass

Vernet syndrome, often referred to as jugular foramen syndrome, is a rare clinical entity characterised by a set of signs and symptoms caused by dysfunction of IX, X and XI cranial nerves. Although paraganglioma of the head and neck is the most frequent aetiology, it may also be caused by meningioma, VIII cranial nerve schwannoma, pontocerebellar cistern metastases, head and neck trauma, infections and very rarely by cholesteatoma which extends to the petrous apex. The authors describe a case of a patient with a jugulotympanic paraganglioma in which evolution ends up in Vernet syndrome. The patient preferred a ‘wait and scan’ strategy. With the lack of data available to develop an unequivocal algorithm for paraganglioma management, we always consider not only age but also comorbidities, prior treatment and progression of the lesion. Each case has to be addressed individually and treatment should be discussed in detail with every patient.

Endoscopic Endonasal Petrosectomy: Anatomical Investigation, Limitations, and Surgical Relevance

2018 ◽  
Vol 16 (5) ◽  
pp. 557-570 ◽  
Author(s):  
Hamid Borghei-Razavi ◽  
Huy Q Truong ◽  
David T Fernandes Cabral ◽  
Xicai Sun ◽  
Emrah Celtikci ◽  
...  
Keyword(s):  
Abducens Nerve ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Computed Tomographic ◽  
Alternative Approach ◽  
Computed Tomographic Scan ◽  
Internal Acoustic Canal

Abstract BACKGROUND The endoscopic endonasal approach (EEA) was recently added to the neurosurgical armamentarium as an alternative approach to the petrous apex (PA) region. However, the maximal extension, anatomical landmarks, and indications of this procedure remain to be established. OBJECTIVE To investigate the limitations and suggest a classification of PA lesions for endoscopic petrosectomy. METHODS Five anatomical specimens were dissected with EEA to the PA. Anatomical landmarks for the surgical steps and maximal limits were noted. Pre- and postprocedural computed tomographic scan and image-guidance were used. Relevant surgical cases were reviewed and presented. RESULTS We defined 3 types of petrosectomy: medial, inferior, and inferomedial. Medial petrosectomy was limited within the paraclival internal carotid artery (ICA) anteriorly, lacerum ICA inferiorly, abducens nerve superiorly, and petrous ICA laterally. Among those, abducens nerve and petrous ICA are surgical limits. Full skeletonization of the paraclival ICA and removal of the lingual process are essential for better access to the medial aspect of PA. Inferior petrosectomy was defined by the lacerum foramen synchondrosis anteriorly, jugular foramen inferiorly, internal acoustic canal posteriorly, and PA superolaterally. Those are surgical limits except for the foramen lacerum synchondrosis. The connective tissue at the pterygosphenoidal fissure was a key landmark for the sublacerum approach. Clinical cases in 3 types of PA lesions were presented. CONCLUSION The EEA provides access to the medial and inferior aspects of the PA. Several technical maneuvers, including paraclival and lacerum ICA skeletonization, sublacerum approach, and lingual process removal, are key to maximize PA drilling.

scholarly journals Invasive Corridor of Clivus Extension in Pituitary Adenoma: Bony Anatomic Consideration, Surgical Outcome and Technical Nuances

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiao Wu ◽  
Han Ding ◽  
Le Yang ◽  
Xuan Chu ◽  
Shenhao Xie ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Cortical Bone ◽  
Cancellous Bone ◽  
Early Stage ◽  
Anatomical Study ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Occipital Condyle ◽  
Hypoglossal Canal ◽  
Internal Acoustic Meatus

BackgroundIt is well known that the clivus is composed of abundant cancellous bone and is often invaded by pituitary adenoma (PA), but the range of these cancellous bone corridors is unknown. In addition, we found that PA with clivus invasion is sometimes accompanied by petrous apex invasion, so we speculated that the petrous apex tumor originated from the clivus cancellous bone corridor. The aim of this study was to test this hypothesis by investigating the bony anatomy associated with PA with clival invasion and its clinical significance.MethodsTwenty-two cadaveric heads were used in the anatomical study to research the bony architecture of the clivus and petrous apex, including six injected specimens for microsurgical dissection and sixteen cadavers for epoxy sheet plastination. The surgical videos and outcomes of PA with clival invasion in our single center were also retrospectively reviewed.ResultsThe hypoglossal canal and internal acoustic meatus are composed of bone canals surrounded by cortical bone. The cancellous corridor within clivus starts from the sellar or sphenoid sinus floor and extends downward, bypassing the hypoglossal canal and finally reaching the occipital condyle and the medial edge of the jugular foramen. Interestingly, we found that the cancellous bone of the clivus was connected with that of the petrous apex through petroclival fissure extending to the medial margin of the internal acoustic meatus instead of a separating cortical bone between them as it should be. It is satisfactory that the anatomical outcomes of the cancellous corridor and the path of PA with clival invasion observed intraoperatively are completely consistent. In the retrospective cohort of 49 PA patients, the clival component was completely resected in 44 (89.8%), and only five (10.2%) patients in the early-stage had partial residual cases in the inferior clivus.ConclusionThe petrous apex invasion of PA is caused by the tumor invading the clivus and crossing the petroclival fissure along the cancellous bone corridor. PA invade the clivus along the cancellous bone corridor and can also cross the hypoglossal canal to the occipital condyle. This clival invasion pattern presented here deepens our understanding of the invasive characteristics of PA.

Sign in / Sign up

Export Citation Format

Share Document