scholarly journals Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study

2018 ◽  
Vol 80 (05) ◽  
pp. 518-526
Author(s):  
Jaafar Basma ◽  
L. Madison Michael ◽  
Jeffrey M. Sorenson ◽  
Jon H. Robertson
Keyword(s):  
Surgical Approach ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Surgical Anatomy ◽  
Cervical Region ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
Microsurgical Anatomy ◽  
Anatomical Landmarks ◽  
Transcervical Approach

Abstract Introduction The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Methods Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Results Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. Conclusion The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.

Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

2021 ◽  
Author(s):  
Aldo Eguiluz-Melendez ◽  
Sergio Torres-Bayona ◽  
María Belen Vega ◽  
Vanessa Hernández-Hernández ◽  
Erik W. Wang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Parapharyngeal Space ◽  
Jugular Bulb ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
The Novel ◽  
Main Trunk ◽  
Transcervical Approach ◽  
Semiquantitative Evaluation ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to describe the anatomical nuances, feasibility, limitations, and surgical exposure of the parapharyngeal space (PPS) through a novel minimally invasive keyhole endoscopic-assisted transcervical approach (MIKET). Design Descriptive cadaveric study. Setting Microscopic and endoscopic high-quality images were taken comparing the MIKET approach with a conventional combined transmastoid infralabyrinthine transcervical approach. Participants Five colored latex-injected specimens (10 sides). Main Outcome Measures Qualitative anatomical descriptions in four surgical stages; quantitative and semiquantitative evaluation of relevant landmarks. Results A 5 cm long inverted hockey stick incision was designed to access a corridor posterior to the parotid gland after independent mobilization of nuchal and cervical muscles to expose the retrostyloid PPS. The digastric branch of the facial nerve, which runs 16.5 mm over the anteromedial part of the posterior belly of the digastric muscle before piercing the parotid fascia, was used as a landmark to identify the main trunk of the facial nerve. MIKET corridor was superior to the crossing of the accessory nerve over the internal jugular vein within 17.3 mm from the jugular process. Further exposure of the occipital condyle, vertebral artery, and the jugular bulb was achieved. Conclusion The novel MIKET approach provides in the cadaver straightforward access to the upper and middle retrostyloid PPS through a natural corridor without injuring important neurovascular structures. Our work sets the anatomical nuances and limitations that should guide future clinical studies to prove its efficacy and safety either as a stand-alone procedure or as an adjunct to other approaches, such as the endonasal endoscopic approach.

scholarly journals The microsurgical anatomy of the glossopharyngeal nerve with respect to the jugular foramen lesions

2004 ◽  
Vol 17 (2) ◽  
pp. 12-21 ◽  
Author(s):  
Mehmet Faik Özveren ◽  
Uđur Türe
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Glossopharyngeal Nerve ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Anatomical Landmarks ◽  
Related Area ◽  
Deep Layers ◽  
Lower Cranial Nerves

Removal of lesions involving the jugular foramen region requires detailed knowledge of the anatomy and anatomical landmarks of the related area, especially the lower cranial nerves. The glossopharyngeal nerve courses along the uppermost part of the jugular foramen and is well hidden in the deep layers of the neck, making this nerve is the most difficult one to identify during surgery. It may be involved in various pathological entities along its course. The glossopharyngeal nerve can also be compromised iatrogenically during the surgical treatment of such lesions. The authors define landmarks that can help identify this nerve during surgery and discuss the types of lesions that may involve each portion of the glossopharyngeal nerve.

Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome

2019 ◽  
Author(s):  
Felipe Constanzo ◽  
Ricardo Ramina ◽  
Mauricio Coelho Neto
Keyword(s):  
Facial Nerve ◽  
Medical Center ◽  
Demographic Data ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Eagle’S Syndrome ◽  
Transcervical Approach ◽  
Marginal Mandibular Branch ◽  
Mean Size ◽  
Mandibular Branch

Abstract Objectives Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy. Design Preset study is a single-center retrospective cohort study. Setting The research was conducted at a tertiary medical center. Participants From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach. Main Outcome Measures Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed. Results Mean size of the styloid processes was of 3.34 cm on the operated side (2.3–4.7 cm) and 2.98 cm on the other (2–4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series. Conclusions Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.

Cervical paragangliomas: diagnosis, management and complications

2001 ◽  
Vol 115 (6) ◽  
pp. 467-474 ◽  
Author(s):  
M. Hossam Thabet ◽  
Hesham Kotob
Keyword(s):  
Carotid Artery ◽  
Superior Laryngeal Nerve ◽  
Carotid Bifurcation ◽  
Styloid Process ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digastric Muscle ◽  
Vascular Injuries ◽  
Nerve Paralysis ◽  
Transcervical Approach

Sixteen patients were diagnosed as suffering from cervical paragangliomas. Eleven patients (68.75 per cent) had twelve carotid paragangliomas (CPs), and five patients (31.25 per cent) had six vagal paragangliomas (VP). One CP (8.33 per cent) originated from paraganglia around the common carotid artery (CCA). Three cases of multiple paragangliomas are presented (18.75 per cent). In 80 per cent (4/5) of VP patients there was widening of the carotid bifurcation similar to that seen with CP. This widening occurred whenever the VP was large enough to grown in between the external carotid artery and internal carotid artery (ECA and ICA). Large VPs may displace the vessels either anterolaterally or anteromedially. Knowledge of the direction of the carotid displacement is essential to avoid intra-operative vascular injuries. Colour flow doppler ultrasound (CFD-US) was found to be a good non-invasive method for diagnosis of vascular neck swellings. It enabled the diagnosis of CP with 100 per cent accuracy, but it was not sufficient for diagnosis of high VP. A transcervical approach, cutting the digastric muscle and the styloid process with the attached ligaments and muscles, was sufficient for excision of most VP. However, midline mandibulotomy might be necessary with high VP. Vascular injuries occurred in 12.5 per cent (2/16) of patients. Superior laryngeal nerve and hypoglossal nerve paralysis occurred, respectively, in (2/11) and (1/11) of patients with CP. Vagal paralysis occurred in all patients with VP. Cerebrovascular accident and post-operative death occurred in one patient (6.26 per cent).

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.

Endoscopic Endonasal Transclival Transcondylar Approach for Foramen Magnum Meningiomas

2015 ◽  
Vol 12 (2) ◽  
pp. 153-162 ◽  
Author(s):  
Wei-Hsin Wang ◽  
Kumar Abhinav ◽  
Eric Wang ◽  
Carl Snyderman ◽  
Paul A Gardner ◽  
...  
Keyword(s):  
Odontoid Process ◽  
Human Head ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Occipital Condyle ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Medial Condyle ◽  
Anterior Arch ◽  
Surgical Corridor

Abstract BACKGROUND The endoscopic endonasal approach provides a direct route to ventral foramen magnum (FM) lesions like meningiomas, which are difficult to access. Endonasal access at the FM is limited laterally by the occipital condyles and inferiorly by the C1 anterior arch and the odontoid process, which may need partial resection. OBJECTIVE We investigated the surgical anatomy and technical nuances for endonasally increasing the surgical corridor at the FM region both laterally and inferiorly. Unique to our report, we quantified the amount of required medial condyle resection to obtain exposure of the lateral aspects of the FM. METHODS Five fresh human head silicone-injected specimens underwent endonasal inferior transclival, transcondylar approaches. The lateral limit of medial condyle resection was defined using a vertical line extending inferiorly from foramen lacerum and its intersection with the occipital condyle. The condylectomy was limited posteriorly by the cortical bone surrounding the hypoglossal canal. The volume of the resected condyle (cubic centimeters) for 10 sides was measured using the pre- and postdissection computed tomography-volumetric analysis. RESULTS The mean percentage condylar volume resected during a unilateral medial condylectomy was 18% (9.7%-28.3%). The surgical corridor was extended inferiorly in all specimens without violating the transverse ligament by drilling the superior aspects of C1 anterior arch and the exposed odontoid tip. These operative nuances were successfully applied in the operating room. CONCLUSION Anatomical landmarks can reliably guide an endonasal anteromedial condyle resection. Minimal condyle resection is required to widen lateral access at the FM, which minimizes the risk of craniocervical instability.

scholarly journals Fully Endoscopic Minimally Invasive Transrectus Capitis Posterior Muscle Triangle Approach to the Posterolateral Condyle and Jugular Tubercle

2017 ◽  
Vol 78 (05) ◽  
pp. 359-370 ◽  
Author(s):  
Wang Mingdong ◽  
Roger Mathias ◽  
Eric Wang ◽  
Paul Gardner ◽  
Hong Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Fourth Ventricle ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Endoscopic Approach ◽  
Occipital Condyle ◽  
Anatomical Landmarks ◽  
Bone Removal ◽  
Soft Tissue Dissection ◽  
Greater Occipital Nerve

Background We evaluated a transrectus capitis posterior muscle triangle approach to the posterolateral foramen magnum, occipital condyles, jugular tubercle, and the fourth ventricle. We also assessed factors that affect the amount of bone removal required. Objective To evaluate if the proposed approach is as effective as standard open approaches to expose the lateral portion of the foramen magnum. Methods The proposed minimally invasive fully endoscopic approach was performed in 15 cadaveric specimens using 4-mm (0- and 45-degree) endoscopes. Results Using a 5-cm straight paramedian incision, the rectus capitis posterior minor and major muscles were partially removed unilaterally, providing a corridor through the muscles to reach the foramen magnum region. After meticulous soft tissue dissection, key anatomical landmarks can be identified such as the greater occipital nerve, the vertebral artery that wraps around the atlanto-occipital joint, and the bony protuberance that heralds the occipital condyle. A suboccipital craniotomy associated with the transcondylar, supracondylar or paracondylar approach is performed depending on the amount of bone removal desired to maximize the surgical view. By doing so, the jugular foramen can be exposed laterally as well as the fourth ventricle medially. Conclusion The proposed endoscopic approach can provide access through the transrectus capitis posterior muscle triangle leading directly to the occipital condyle. A stepwise approach is critical to gain a surgical corridor to the inferolateral petroclival region and the fourth ventricle.

scholarly journals Morphometric Study of the Jugular Foramen in Northwest Indian Population

2012 ◽  
Vol 46 (4) ◽  
pp. 165-171 ◽  
Author(s):  
Anjali Aggarwal ◽  
Tulika Gupta ◽  
Harjeet Kaur ◽  
Anjali Singla ◽  
Daisy Sahni
Keyword(s):  
Indian Population ◽  
Bone Growth ◽  
Anatomical Variations ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Occipital Condyle ◽  
Morphometric Study ◽  
Carotid Canal ◽  
Jugular Fossa ◽  
The Right

ABSTRACT Context Most of the approaches for skull base surgeries are designed to drill the bone around the jugular foramen for proper exposure. In order to achieve this, an understanding of normal morphometric dimensions of jugular foramen is necessary. Aim To conduct the morphometric analysis and anatomical variations of jugular foramen (JF) in Northwest Indian population. Settings and design Anatomic study using human skulls. Materials and methods Anteroposterior and mediolateral diameter of jugular foramen, depth (if domed) and width of jugular fossa were measured with the help of digital vernier caliper. Statistical analysis used The mean, standard deviation (SD) and range of each dimension was computed. A comparison between right and left jugular foramina was made by using student's t-test. Results Mediolateral diameter of jugular foramen and width of jugular fossa was significantly higher on the right side. An abnormal unilateral blockage of jugular foramen by a bone growth converting it into a slit was noted with anteroposterior (AP) diameter of 2.37 mm in one skull. Bilateral complete septation of jugular foramen into two and three compartments was observed in 2 (4%) and 3 (6%) of the skulls respectively. The domed bony roof was noticed in 66% of the skulls on both the sides. Conclusion The observed variations of JF are possibly due to constitutional, racial or genetic factors. Knowledge of the observed variations of this foramen may be important for neurosurgeons, radiologists and anthropologists. Key message The total subdivision of jugular foramen is not common in our environment. The jugular foramen is generally larger on right side. This study supports reported morphometric variations of jugular foramen, besides adding data on the Northwest Indian population. Abbreviation CC: carotid canal; BO: basi-occiput; OC: occipital condyle; JF: jugular foramen; S: styloid process. How to cite this article Singla A, Sahni D, Aggarwal A, Gupta T, Kaur H. Morphometric Study of the Jugular Foramen in Northwest Indian Population. J Postgrad Med Edu Res 2012;46(4):165-171.

Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images

2007 ◽  
Vol 122 (6) ◽  
pp. 628-634 ◽  
Author(s):  
S Kanzaki ◽  
H Nameki
Keyword(s):  
Surgical Approach ◽  
Parapharyngeal Space ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Resonance Imaging ◽  
Large Tumour ◽  
Transcervical Approach ◽  
Skull Base Approach ◽  
Inferior Portion ◽  
Superior Portion

AbstractMany approaches to the parapharyngeal space have been reported. However, few reports describe parapharyngeal space tumours and the best surgical approach to these tumours. We retrospectively examined the surgical approaches we used to resect 22 parapharyngeal space tumours. In order to determine the best surgical approach for each tumour, we first subdivided the parapharyngeal space into six compartments, based on anatomical landmarks seen on computed tomography and/or magnetic resonance imaging scans. We then determined the location of each tumour relative to these six parapharyngeal space compartments. In our series of cases, we found that large tumours spanning the superior portion of the parapharyngeal space could be completely removed through a skull base approach. To remove a large tumour in the middle and inferior portion of the parapharyngeal space, a transparotid approach was the most suitable. Finally, a tumour in the inferior portion of the parapharyngeal space was best accessed through a transcervical approach.

scholarly journals A Giant Congenital Mastoid Cholesteatoma With Extension to the Occipital Condyle

2021 ◽  
pp. 014556132110079
Author(s):  
Jae Hyung Heo ◽  
Jin Woong Choi
Keyword(s):  
Facial Nerve ◽  
Surgical Approach ◽  
Complete Removal ◽  
Jugular Foramen ◽  
Sigmoid Sinus ◽  
Occipital Condyle ◽  
Epithelial Tissue ◽  
Fallopian Canal ◽  
Surgical Methods ◽  
Subtotal Petrosectomy

A congenital mastoid cholesteatoma (CMC) is a keratinizing epithelium originating from embryological epithelial tissue of the mastoid. It is often not diagnosed until it becomes large because of its rarity and indolent nature. Although there are a few reports on giant CMC, its exact extensions have not been well described, and detailed information regarding surgical methods is lacking, especially in giant CMC involving the occipital condyle and the middle and posterior cranial fossae. In this article, we report a case involving a 70-year-old woman with a giant CMC that extended inferiorly to the occipital condyle. The CMC eroded the middle and posterior cranial fossae, sigmoid sinus plate, and fallopian canal of the facial nerve. For complete removal, we used a subtotal petrosectomy in conjunction with an exposure of the cranial cervical junction and a wide decompression of the suboccipit. The boundaries of exposure were similar to those of a petro-occipital transsigmoid approach which is usually used for management of tumor involving the jugular foramen. The wide exposure allowed for complete removal of the lesion without any complications. Thus, we recommend this surgical approach for management of the giant CMC involving the occipital condyle and the middle and posterior cranial fossae.

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