scholarly journals Suprabulbar Approach to Jugular Fossa Tumors: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kyle C Wu ◽  
Emad Aboud ◽  
Ossama Al-Mefty
Keyword(s):  
Doppler Ultrasonography ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Neurological Dysfunction ◽  
Impaired Hearing ◽  
Venous Flow ◽  
Jugular Fossa ◽  
Distal Aspect ◽  
Lower Cranial Nerves

Abstract Owing to their scarcity, location, and intricate neurovascular associations, jugular fossa tumors are among the most challenging pathologies encountered by the neurosurgeon.1 While paragangliomas originate within and often occlude the jugular bulb, schwannomas and meningiomas are extra-bulbar and typically do not impede venous flow.2 Schwannomas typically arise from an extradural origin, expanding the jugular foramen.3-5 Meningiomas are intradural and cause hyperostosis of the jugular tubercle.6 We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window6 that has been detailed in cadaveric studies.7,8 This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves. The carotid artery can be identified by neuronavigation and micro-Doppler ultrasonography. This approach provides a direct lateral trajectory with a short distance to the jugular fossa and cerebellopontine angle. Early exposure and central debulking of the tumor minimize manipulation of the exquisitely sensitive lower cranial nerves. The distal aspect of these tumors can be removed with endoscopic assisted techniques.9 The first patient is a 49-yr-old woman with a previously irradiated schwannoma who presented with worsening neurologic deficits—an extradural suprabulbar approach was used to resect this tumor. The second patient is a 27-yr-old woman with an enlarging meningioma and associated neurological dysfunction; this tumor was resected using the suprabulbar approach with opening of the presigmoid dura. Both patients have consented to surgery and publication of images. Image at 2:27 and 6:38 reprinted from Arnautović et al, with permission from JNSPG. Image at 2:50 and 6:45 ©Ossama Al-Mefty 1997, reused with permission.

Lower Skull Base: Anatomic Study with Surgical Implications

1995 ◽  
Vol 104 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Essam Saleh ◽  
Maged Naguib ◽  
Yasar Cokkeser ◽  
Miguel Aristegui ◽  
Mario Sanna
Keyword(s):  
Connective Tissue ◽  
Skull Base ◽  
Fibrous Tissue ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Microsurgical Anatomy ◽  
Anatomic Study ◽  
Hypoglossal Canal ◽  
Lower Cranial Nerves

With advances in the lateral approaches to the skull base and the increasing success of the management of jugular foramen lesions, a thorough knowledge of the anatomy of this region is needed. The purpose of the present work is to study the detailed microsurgical anatomy of the lower skull base and the jugular foramen area as seen through the lateral approaches. Forty preserved skull base specimens and 5 fresh cadavers were dissected. The shape of the jugular bulb and its relationship to nearby structures were recorded. The different venous connections of the bulb were noted. The hypoglossal canal was identified and its contents were observed. The lower cranial nerves were studied at the level of the upper neck, at their exit from the inferior skull base, and in the jugular foramen. The results of the present study showed the complex and variable anatomy of this area. The classic compartments of the jugular foramen were not always present. Cranial nerves IX through XI followed different patterns while passing through the jugular foramen, being separated from the jugular bulb by bone, thick fibrous tissue, or thin connective tissue.

scholarly journals Surgical treatment of dumbbell-shaped jugular foramen schwannomas

2004 ◽  
Vol 17 (2) ◽  
pp. 56-62 ◽  
Author(s):  
Paulo A. S. Kadri ◽  
Ossama Al-Mefty
Keyword(s):  
Cranial Nerve ◽  
Recovery Of Function ◽  
Preoperative Evaluation ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Senior Author ◽  
Neurological Deficits ◽  
Cystic Degeneration ◽  
Lower Cranial Nerves

Object Schwannomas of the jugular foramen are rare, comprising between 2 and 4% of intracranial schwannomas. The authors retrospectively analyzed their surgical experience with schwannomas of the lower cranial nerves that presented with intra- and extracranial extensions through an enlarged jugular foramen. The transcondylar suprajugular approach was used without sacrificing the labyrinth or the integrity of the jugular bulb. In this report the clinical and radiological features are discussed and complications are analyzed. Methods This retrospective study includes six patients (three women and three men, mean age 31.6 years) with dumbbell-shaped jugular foramen schwannomas that were surgically treated by the senior author during a 5.5-year period. One patient had undergone previous surgery elsewhere. Glossopharyngeal and vagal nerve deficits were the most common signs (appearing in all patients), followed by hypoglossal and accessory nerve deficits (66.6%). Two or more signs or symptoms were present in every patient. Three tumors presented with cystic degeneration. In four patients the jugular bulb was not patent on neuroimaging studies. The suprajugular approach was used in five patients; the origin of the tumor from the 10th cranial nerve could be defined in three of them. All lesions were completely resected. No death or additional postoperative cranial nerve deficits occurred in this series. Aspiration pneumonia developed in one patient. Preoperative deficits of the ninth and 10th cranial nerves improved in one third of the patients and half recovered mobility of the tongue. No recurrence was discovered during the mean follow-up period of 32.8 months. Conclusions With careful, extensive preoperative evaluation and appropriate planning of the surgical approach, dumbbell-shaped jugular foramen schwannomas can be radically and safely resected without creating additional neurological deficits. Furthermore, recovery of function in the affected cranial nerves can be expected.

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.

Myeloma Manifesting as a Large Jugular Tumor: Case Report

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 971-977 ◽  
Author(s):  
Shigeru Miyachi ◽  
Makoto Negoro ◽  
Kiyoshi Saito ◽  
Kyoko Nehashi ◽  
Kenichiro Sugita
Keyword(s):  
Case Report ◽  
Osteolytic Lesion ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Arteriovenous Shunting ◽  
Hypervascular Tumor ◽  
Multiple Myelomas ◽  
Lower Cranial Nerves

Abstract The authors report a case of cranial plasmacytoma with multiple myelomas and palsy of the lower cranial nerves. The osteolytic lesion adjacent to the jugular foramen was demonstrated by an angiogram to be exceedingly hypervascular, with arteriovenous shunting resembling that seen in paragangliomas. Forty-five cases of cranial and intracranial plasmacytoma from the literature were reviewed. The findings indicate that a cranial plasmacytoma commonly appears to be a hypervascular tumor, whereas most dural tumors or intraparenchymal tumors have poor vascularity.

scholarly journals Morphometric Study of Jugular Foramen and Jugular Fossa of Dried Adult Human Skulls and Its Clinical Significance

2019 ◽  
Vol 08 (04) ◽  
pp. 160-164
Author(s):  
Govindarajan Amudha ◽  
Chandrasekaran Nandhini Aishwarya ◽  
Deborah Joy Hepzibah ◽  
Vaujapuri Anandhavadivel Kesavan ◽  
Anaimalai Kandavadivelu Manicka Vasuki
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Morphometric Study ◽  
Clear Understanding ◽  
Inferior Petrosal Sinus ◽  
Jugular Fossa ◽  
Human Skulls ◽  
The Right

Abstract Introduction Jugular foramen is one of the most fascinating foramina of the human skull. It is a complex, irregular bony canal located between the occipital bone and petrous part of the temporal bone. Many important structures, like 9th, 10th, 11th cranial nerves, meningeal branch of occipital and ascending pharyngeal arteries, internal jugular vein, and inferior petrosal sinus, are passing through it. The jugular fossa has a septum and a dome. The septum divides the foramen into two compartments: anteromedial compartment (pars nervosa) and posterolateral compartment (pars vascularis). The dome contains superior bulb of internal jugular vein. The architecture of the foramen varies in size, shape, and laterality besides differences related to sex and race. The morphometric measurements of jugular foramen are very important for neurosurgeries and head and neck surgeries. Objectives The aim of the present study is to study the morphology of jugular foramen along with its dimensions, compartments, presence of partial or complete septa and dome. Materials and Methods A total number of 60 jugular foramina were examined from 30 adult dry human skulls of unknown age and sex from the Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore. Measurements were taken using Digital Vernier calipers. Results were analyzed statistically. Results The length, width, and surface area of jugular foramen of right side were measured and compared with the left side. Length and width of the jugular foramen was significantly higher on the right side. The presence of partial septum was found in 27 skulls (90%) on the right side and 29 skulls (99.7%) on the left side, respectively. Dome was present in 100% of the jugular foramina on the right side and 90% of the jugular foramina on the left side. Separate opening for inferior petrosal sinus was found in eight skulls (27%) on the right side and four skulls (13%) on the left side. Conclusion This study provides a clear understanding of anatomy of jugular foramen and supports the reported morphometric variations. The morphometric variations of jugular foramen in the parameters of the skull are probably due to ethnic and racial factors. Knowledge of these variations is important for neurosurgeons and radiologists who deal with space occupying lesions of the structures surrounding jugular foramen. This study may be helpful for ENT surgeons while performing middle ear surgeries.

Microsurgical Resection of Glomus Jugulare Tumors With Facial Nerve Reconstruction: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E1-E1 ◽  
Author(s):  
Duarte N C Cândido ◽  
Jean Gonçalves de Oliveira ◽  
Luis A B Borba
Keyword(s):  
Facial Nerve ◽  
Infratemporal Fossa ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Senior Author ◽  
Nerve Reconstruction ◽  
Glomus Jugulare ◽  
Carotid Canal

Abstract Paragangliomas are tumors originating from the paraganglionic system (autonomic nervous system), mostly found at the region around the jugular bulb, for which reason they are also termed glomus jugulare tumors (GJT). Although these lesions appear to be histologically benign, clinically they present with great morbidity, especially due to invasion of nearby structures such as the lower cranial nerves. These are challenging tumors, as they need complex approaches and great knowledge of the skull base. We present the case of a 31-year-old woman, operated by the senior author, with a 1-year history of tinnitus, vertigo, and progressive hearing loss, that evolved with facial nerve palsy (House-Brackmann IV) 2 months before surgery. Magnetic resonance imaging and computed tomography scans demonstrated a typical lesion with intense flow voids at the jugular foramen region with invasion of the petrous and tympanic bone, carotid canal, and middle ear, and extending to the infratemporal fossa (type C2 of Fisch's classification for GJT). During the procedure the mastoid part of the facial nerve was identified involved by tumor and needed to be resected. We also describe the technique for nerve reconstruction, using an interposition graft from the great auricular nerve, harvested at the beginning of the surgery. We achieved total tumor resection with a remarkable postoperative course. The patient also presented with facial function after 6 months. The patient consented with publication of her images.

Carotid fibromuscular dysplasia and paresis of lower cranial nerves (Collet-Sicard syndrome)

1982 ◽  
Vol 56 (6) ◽  
pp. 850-853 ◽  
Author(s):  
Ulf Havelius ◽  
Bengt Hindfelt ◽  
Jan Brismar ◽  
Sten Cronqvist
Keyword(s):  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Clinical Symptoms ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Acute Onset ◽  
Content Type ◽  
Lower Cranial Nerves ◽  
Base Of The Skull ◽  
Symptoms And Signs

✓ A patient suffered the acute onset of unilateral pareses of the ninth through 12th cranial nerves (Collet-Sicard syndrome). Ipsilateral retrograde jugular phlebography and carotid angiography revealed irregular aneurysmal changes of the internal carotid artery at the base of the skull, causing compression of the internal jugular vein below the jugular foramen. This finding is discussed in relation to the clinical symptoms and signs, and possible mechanisms are examined. Family history as well as the clinical and roentgenological findings were compatible with a diagnosis of fibromuscular dysplasia.

scholarly journals Late Pseudo-Exacerbation of Myasthenia Gravis Due to Ectopic Thymoma Invading Lower Cranial Nerves

1990 ◽  
Vol 17 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Gregg MacLean ◽  
Alan Guberman ◽  
Antonio Giulivi
Keyword(s):  
Myasthenia Gravis ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Cervical Mass ◽  
Ectopic Thymoma ◽  
Cranial Nerve Palsies ◽  
Lower Cranial Nerves ◽  
Repeated Aspiration

ABSTRACT:Dysarthria, dysphagia and repeated aspiration in a 54-year-old woman diagnosed and treated for myasthenia gravis 7 years earlier were initially thought to represent a late exacerbation of myasthenia. A cervical mass invading the jugular foramen and causing multiple lower cranial nerve palsies was biopsied and found to represent invasive ectopic thymoma.

The Juxtacondylar Approach to the Jugular Foramen

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS75-ONS81 ◽  
Author(s):  
Michaël Bruneau ◽  
Bernard George
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerves ◽  
Transverse Process ◽  
Petrous Bone ◽  
Jugular Foramen ◽  
External Carotid ◽  
Anterolateral Approach ◽  
Bone Drilling ◽  
The Third ◽  
Lower Cranial Nerves

Abstract Objective: We sought to describe the juxtacondylar approach to jugular foramen tumors. Methods: Through an anterolateral approach, the third segment of the vertebral artery (between C2 and the dura mater) is controlled. The C1 transverse process of the atlas, which is located just inferiorly to the jugular foramen, is then removed. The dissection of the internal jugular vein is performed as high as possible, with control of the IXth, Xth, XIth, and XIIth cranial nerves. If required by a tumor extending into the neck, the internal and external carotid arteries can be exposed and controlled. Through a partial mastoidectomy and after removal of the bone covering the jugular tubercle, the end of the sigmoid sinus and then the posteroinferior part of the jugular foramen are reached. RESULTS: This technique is efficient to expose tumors extending into the jugular foramen. Contrary to the infratemporal approach, it has the main advantage of avoiding petrous bone drilling and associated potential complications. Lower cranial nerves are well exposed in the neck. In patients with schwannomas, complete resection with selective dividing of only the few involved rootlets can be achieved. Conclusion: The juxtacondylar approach is an efficient approach to tumors located in the jugular foramen. It necessitates control of the third segment of the vertebral artery but has the advantage of avoiding complications associated with petrous bone drilling. Extension beyond the jugular foramen requires combination with an infratemporal or a retrosigmoid approach.

The microsurgical anatomy of the jugular foramen

1995 ◽  
Vol 83 (5) ◽  
pp. 903-909 ◽  
Author(s):  
S. Adetokunboh Ayeni ◽  
Kenji Ohata ◽  
Kiyoaki Tanaka ◽  
Akira Hakuba
Keyword(s):  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
The Right ◽  
Posterior Meningeal Artery ◽  
Distal Sigmoid

✓ The microsurgical anatomy of the jugular foramen was studied in 10 fixed cadavers, each cadaver consisting of the whole head and neck. Five of the cadavers were injected with latex. The jugular foraminal region was exposed using the infratemporal fossa type A approach of Fisch and Pillsbury in five cadavers (10 sides) and the combined cervical dissection—mastoidectomy—suboccipital craniectomy approach in five cadavers (10 sides). The right foramen was larger than the left in seven cases (70%), equal in two cases (20%), and smaller in one case (10%). The dura covering the intracranial portal of the foramen had two perforations, a smaller anteromedial perforation through which passed the ninth cranial nerve (CN IX), and a larger posterolateral perforation, through which passed the 10th and 11th cranial nerves (CNs X and XI) and the distal sigmoid sinus. The perforations were separated by a fibrous septum in 16 specimens (80%). After exiting the posterior fossa, CNs IX, X, and XI all lay anteromedial to the superior jugular bulb (SJB) within the jugular foramen. The inferior petrosal sinus (IPS) entered the foramen between CNs IX and X in most cases; however, in 10% of our cases it entered the foramen between CNs X and XI, and in 10% it entered the foramen caudal to CN XI. The IPS terminated in the SJB in 90% of our cases; in 40%, the IPS termination consisted of multiple channels draining into both the SJB and internal jugular vein. This study shows that the arrangement of the neurovascular structures within the jugular foramen does not conform to the hitherto widely accepted notion of discrete compartmentalization into an anteromedial pars nervosa containing CN IX and the IPS and a posterolateral pars venosa containing the SJB, CNs X and XI, and the posterior meningeal artery.

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