Suprajugular extension of the retrosigmoid approach: microsurgical anatomy

2014 ◽  
Vol 121 (2) ◽  
pp. 397-407 ◽  
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Noritaka Komune ◽  
Koichi Miki ◽  
Toshio Matsushima ◽  
...  
Keyword(s):  
Skull Base ◽  
Cerebellopontine Angle ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Glossopharyngeal Nerve ◽  
Retrosigmoid Approach ◽  
Illustrative Case ◽  
Microsurgical Anatomy ◽  
Total Removal ◽  
Skull Base Approach

Object Jugular foramen tumors often extend intra- and extracranially. The gross-total removal of tumors located both intracranially and intraforaminally is technically challenging and often requires a combined skull base approach. This study presents a suprajugular extension of the retrosigmoid approach directed through the osseous roof of the jugular foramen that allows the removal of tumors located in the cerebellopontine angle with extension into the upper part of the foramen, with demonstration of an illustrative case. Methods The cerebellopontine angles and jugular foramina were examined in dry skulls and cadaveric heads to clarify the microsurgical anatomy around the jugular foramen and to define the steps of the suprajugular exposure. Results The area drilled in the suprajugular approach is inferior to the acoustic meatus, medial to the endolymphatic depression and surrounding the superior half of the glossopharyngeal dural fold. Opening this area exposed the upper part of the jugular foramen and extended the exposure along the glossopharyngeal nerve below the roof of the jugular foramen. In the illustrative case, a schwannoma originating from the glossopharyngeal nerve in the cerebellopontine angle and extending below the roof of the jugular foramen and above the jugular bulb was totally removed without any postoperative complications. Conclusions The suprajugular extension of the retrosigmoid approach will permit removal of tumors located predominantly in the cerebellopontine angle but also extending into the upper part of the jugular foramen without any additional skull base approaches.

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.

History, Variations, and Extensions of the Retrosigmoid Approach: Anatomical and Literature Review

2021 ◽  
Author(s):  
Jaafar Basma ◽  
Christos Anagnostopoulos ◽  
Andrei Tudose ◽  
Mikhail Harty ◽  
L. Madison Michael ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Jugular Foramen ◽  
Retrosigmoid Approach ◽  
Anatomical Landmarks ◽  
Posterior Fossa Surgery ◽  
Different Types ◽  
Microsurgical Techniques ◽  
Subarachnoid Spaces ◽  
Far Lateral ◽  
Suboccipital Approach

AbstractThe retrosigmoid approach is the workhorse for posterior fossa surgery. It gives a versatile corridor to tackle different types of lesions in and around the cerebellopontine angle. The term “extended” has been used interchangeably in the literature, sometimes creating confusion. Our aim was to present a thorough analysis of the approach, its history, and its potential extensions. Releasing cerebrospinal fluid from the subarachnoid spaces and meticulous microsurgical techniques allowed for the emergence of the retrosigmoid approach as a unilateral variation of the traditional suboccipital approach. Anatomical landmarks are helpful in localizing the venous sinuses and planning the craniotomy, and Rhoton's rule of three is the key to unlock difficult neurovascular relationships. Extensions of the approach include, among others, the transmastoid, supracerebellar, far-lateral, jugular foramen, and perimeatal approaches. The retrosigmoid approach applies to a broad range of pathologies and, with its extensions, can provide adequate exposure, obviating the need for extensive and complicated approaches.

scholarly journals Microvascular Decompression for Geniculate Neuralgia through a Retrosigmoid Approach

2018 ◽  
Vol 80 (S 03) ◽  
pp. S322-S322
Author(s):  
Vincent N. Nguyen ◽  
Jaafar Basma ◽  
Jeffrey Sorenson ◽  
L. Madison Michael
Keyword(s):  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Senior Author ◽  
Retrosigmoid Approach ◽  
Microsurgical Anatomy ◽  
Pain Syndromes ◽  
Large Vein ◽  
Microsurgical Techniques ◽  
Nervus Intermedius

Objectives To describe a retrosigmoid approach for the microvascular sectioning of the nervus intermedius and decompression of the 5th and 9th cranial nerves, with emphasis on microsurgical anatomy and technique. Design A retrosigmoid craniectomy is performed in the lateral decubitus position. The dura is opened and cerebrospinal fluid (CSF) is released from the cisterna magna and cerebellopontine cistern. Dynamic retraction without rigid retractors is performed. Subarachnoid dissection of the cerebellopontine angle exposes the 7th to 8th nerve complex. A neuromonitoring probe is used with careful inspection of the microsurgical anatomy to identify the facial nerve and the nervus intermedius as they enter the internal auditory meatus. The nervus intermedius is severed. A large vein coursing superiorly across cranial 9th nerve was coagulated and cut. A Teflon pledget is inserted between a small vessel and the 5th nerve. Photographs of the region are borrowed from Dr. Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior author performed the surgery. The video was edited by Drs. V.N. and J.B. Outcome Measures Outcome was assessed by postoperative neurological function. Results The nervus intermedius was successfully cut and the 5th and 9th nerves were decompressed. The patient's pain resolved after surgery and at later follow-up. Conclusions Understanding the microsurgical anatomy of the cerebellopontine angle is necessary to identify the cranial nerves involved in facial pain syndromes. Subarachnoid dissection and meticulous microsurgical techniques are key elements for a successful microvascular decompression.The link to the video can be found at: https://youtu.be/pV5Wip7WusE.

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.

scholarly journals Decompression of the internal auditory canal via the retrosigmoid approach in a patient with Camurati-Engelmann disease: illustrative case

2021 ◽  
Vol 1 (4) ◽  
Author(s):  
Salah-Eddine Achahbar ◽  
Thomas Somers ◽  
Tony Van Havenbergh
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Internal Auditory Canal ◽  
Vestibular Function ◽  
Retrosigmoid Approach ◽  
Foraminal Stenosis ◽  
Illustrative Case ◽  
Vestibulocochlear Nerve ◽  
Cranial Neuropathies ◽  
Engelmann Disease

BACKGROUNDCamurati-Engelmann disease (CED) is a rare condition characterized by hyperostosis of the long bones and skull base. Symptoms include contractures and pain in affected extremities but can also include manifestations of cranial hyperostosis such as intracranial hypertension, Chiari malformation, exophthalmia, frontal bossing, and several cranial neuropathies due to cranial foraminal stenosis.OBSERVATIONSThis report describes a 27-year-old patient with suspected CED who developed progressive intermittent facial nerve paresis, hemifacial spasms, and a decrease in hearing. There were no symptoms of increased intracranial pressure or vertigo. Radiological evaluation showed a significant thickening of the skull base with serious bilateral internal auditory canal stenosis. Because of the progressive nature of the aforementioned cranial neuropathies in combination with the correlating severe radiological compression, a surgical decompression of the facial nerve and vestibulocochlear nerve was performed via a retrosigmoid approach with intraoperative monitoring. Postoperative facial nerve function was intact. Hearing and vestibular function were unchanged. There were no more episodes of facial nerve palsy or spasm.LESSONSTo the authors’ knowledge, this is the first report to describe decompression of the internal auditory canal via a retrosigmoid approach for symptomatic facial and cochlear nerve compression in a patient with CED.

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.

scholarly journals Combined Presigmoid and Retrosigmoid Approach to Petroclival Meningiomas

2018 ◽  
Vol 79 (S 05) ◽  
pp. S402-S403
Author(s):  
Marcio Rassi ◽  
Johnni Zamponi ◽  
Duarte Cândido ◽  
Jean Oliveira ◽  
Gustavo Passos ◽  
...  
Keyword(s):  
Skull Base ◽  
Venous Drainage ◽  
Clinical History ◽  
Jugular Bulb ◽  
Retrosigmoid Approach ◽  
Limiting Factor ◽  
Posterior Aspect ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
Transtentorial Approach

Introduction The management of petroclival meningiomas is among the most intimidating in neurosurgery, due to its difficult accessibility and close relationship with vital structures; therefore, an appropriate exposure is mandatory. We present a surgical video demonstrating a presigmoid transtentorial approach, associated with the opening of the retrosigmoid dura to a petroclival meningioma, performed by the senior surgeon (L.A.B.B.), along with its indications and pitfalls. Approach Decision The patient's clinical history is summed to the tumor's radiological features as its extension, vascularization, and venous drainage, when selecting the appropriate approach. The presigmoid transtentorial approach offers a wide exposure of the petroclival area along with the tumor's attachment. Its association with the retrosigmoid route allows the surgeon to freely work through multiple paths, and parallel to the skull base, reducing the traction in the temporal lobe. Clinical Case This is a 39-year-old female presenting with trigeminal neuralgia. Imaging depicted a petroclival meningioma, extending from the posterior aspect of the cavernous sinus to the cerebellopontine angle, extending inferiorly to the jugular bulb. A Simpson II resection was achieved through a combined presigmoid and retrosigmoid approach, and the patient was discharged with no complications or new deficits. Conclusion Petroclival meningiomas are a formidable and surgically treatable disease. The appropriate approach is design to each patient and should not be the limiting factor for total tumor removal, which is truly given by the absence of a dissection plane between the tumor and the brainstem, nerves and vascular structures of the skull base.The link to the video can be found at: https://youtu.be/MFjqZvElBSo.

Meningiomas of the Jugular Foramen

1992 ◽  
Vol 106 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Timothy B. Molony ◽  
Derald E. Brackmann ◽  
William W. M. Lo
Keyword(s):  
Skull Base ◽  
Signs And Symptoms ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Nerve Tissue ◽  
Management Guidelines ◽  
Glomus Tumors ◽  
The Past ◽  
Radiologic Evaluation ◽  
Surrounding Bone

Meningiomas of the jugular foramen manifest the same signs and symptoms as glomus Jugulare tumors. They arise from arachnoid cells lining the jugular bulb and grow slowly, infiltrating the temporal bone and posterior fossa. These lesions, however, are more clinically treacherous than glomus tumors. Meningiomas Infiltrate surrounding bone and nerve tissue and require wide margins of resection to prevent recurrence. Eight of these lesions have been managed in the past 5 years at the House Ear Clinic using modern imaging and skull base techniques. Two have recurred after “total” microsurgical removal. Presentation, radiologic evaluation, and management guidelines are reviewed.

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