Jugular foramen schwannomas

1984 ◽  
Vol 60 (5) ◽  
pp. 1045-1053 ◽  
Author(s):  
Andrew H. Kaye ◽  
Joseph F. Hahn ◽  
Sam E. Kinney ◽  
Russell W. Hardy ◽  
Janet W. Bay
Keyword(s):  
Posterior Fossa ◽  
Cranial Nerves ◽  
Cleveland Clinic ◽  
Jugular Foramen ◽  
Growth Patterns ◽  
Exact Nature ◽  
Loss Of Function ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Base Of The Skull

✓ Thirteen patients with schwannomas of the jugular foramen were operated on at the Cleveland Clinic between 1974 and 1983. The authors' experience in managing these rare tumors is presented. Three major growth patterns of jugular foramen schwannoma were seen, and it is postulated that the position of the tumor depends on its point of origin from the nerves as they pass through the pars nervosa of the jugular foramen. The more distal lesions will expand inferiorly out of the base of the skull, and the more proximal lesions will enlarge into the posterior fossa. Tumors in the mid region will tend to expand primarily into bone. The schwannoma was primarily intracranial in six patients. In five patients the tumor expanded the bone at the base of the skull, with only a small intracranial component, and in two patients the tumor was primarily extracranial, with a small extension into the bone or posterior fossa. The presentation of the patients varied according to the tumor growth pattern. Deafness, vertigo, and ataxia were present in all patients with a major intracranial component, and in most of these there were only minimal deficits of the jugular foramen nerves. By contrast, lower cranial nerve involvement, including hoarseness and weakness of the trapezius and sternocleidomastoid muscles, occurred in patients in whom the tumor was primarily within the bone or extracranial. Three of the five patients with the major component of the schwannoma within the bone also had deafness. Symptomatic history was longest in those with tumor mainly involving the bone at the base of the skull, and shortest in patients with entirely extracranial tumor. Surgical resection was accomplished with a joint neurosurgical-otological approach, usually combining a posterior fossa exploration with either a translabyrinthine transcochlear or infralabyrinthine procedure. The exact nature of the operation depended upon the presence of intracranial tumor and on the extent of bone or extracranial involvement. Total excision was performed in all cases. There was no operative mortality, and surgery resulted in loss of function of the ninth, 10th, and 11th cranial nerves in most patients. The major postoperative morbidity consisted of swallowing difficulties and sputum aspiration.

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.

Posttraumatic Delayed Jugular Foramen Syndrome in a Toddler

2021 ◽  
Author(s):  
Cristina Toledo-Gotor ◽  
Nerea Gorría ◽  
Miren Oscoz ◽  
Katia Llano ◽  
Pablo la Fuente Rodríguez-de ◽  
...  
Keyword(s):  
Physical Examination ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Exceptional Case ◽  
Cerebellar Tonsil ◽  
Occipital Condyle ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Blunt Head Trauma ◽  
Condyle Fracture

Abstract Background Multiple lower cranial nerve palsies have been attributed to occipital condyle fractures in older children and adults, but no clinical details of other possible mechanisms have been described in infants. Case Report A 33-month-old boy suffered blunt head trauma. A bilateral skull base fracture was diagnosed, with favorable outcome during the first days after trauma. On the sixth day, the patient began to refuse drinking and developed hoarseness. Physical examination and additional investigations revealed paralysis of left VII, IX, X, and XI cranial nerves. A follow-up computed tomography (CT) scan disclosed a left petrous bone fracture involving the lateral margin of the jugular foramen, and a cranial magnetic resonance imaging (MRI) study showed a left cerebellar tonsil contusion. He improved after methylprednisolone was started. Three months later, he was asymptomatic, although mild weakness and atrophy of the left sternocleidomastoid and trapezius muscles remained 1 year later. Discussion A posttraumatic “jugular foramen syndrome” is rare in children, but it has been reported shortly after occipital condyle fracture, affecting mainly IX, X, and XI cranial nerves. In this toddler, delayed symptoms appeared with unilateral involvement. While an occipital fracture was ruled out, neuroimaging findings suggest the hypothesis of a focal contusion as a consequence of a coup-contrecoup injury. Conclusion This exceptional case highlights the importance of gathering physical examination, anatomical correlation, and neuroimaging to yield a diagnosis.

The cranial nerves

2021 ◽  
pp. 125-156
Author(s):  
Daniel R. van Gijn ◽  
Jonathan Dunne
Keyword(s):  
Cranial Nerves ◽  
Jugular Foramen ◽  
Foramen Ovale ◽  
Superior Orbital Fissure ◽  
Stylomastoid Foramen ◽  
Foramen Rotundum ◽  
Pass Through ◽  
Base Of The Skull ◽  
Control Balance ◽  
Internal Acoustic Canal

There are 12 pairs of cranial nerves that are individually named and numbered using Roman numerals. Only some cranial nerves are mixed in function, i.e. they carry both sensory and motor fibres; others are purely sensory or motor and some may also carry pre- or post-ganglionic parasympathetic fibres. They pass through foramina in the base of the skull and are the olfactory (through cribriform plate to the nasal cavity), optic (through the optic foramen to the eye), oculomotor (through the cavernous sinus and superior orbital fissure to supply the eye), trochlear (as per oculomotor), trigeminal (three main branches that pass through the superior orbital fissure, foramen rotundum and foramen ovale, respectively), abducens (as per oculomotor), facial (through stylomastoid foramen to supply muscles of facial expression), vestibulocochlear (through the internal acoustic canal to control balance and hearing), glossopharyngeal, vagus, accessory (all pass through the jugular foramen) and hypoglossal (through the hypoglossal canal to control movements of the tongue) nerves.

scholarly journals Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

2012 ◽  
Vol 18 (2) ◽  
pp. 183-192
Author(s):  
Forhad H Chowdhury ◽  
Mohammod R Haque ◽  
Mahmudul Hasan
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Young Male ◽  
Carotid Bifurcation ◽  
Short Review ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Cervical Approach ◽  
High Cervical

Introduction: Jugular foramen tumor is a rare tumor. Jugular foramen schwannoma is rarer. This type of tumor may present in combination of different cranial nerve palsies in the form of different syndromes or may also be diagnosed incidentally. Management of such tumor is not straight forward.Case reports: Two young male presented with headache, vomiting, gait instability, right sided hearing loss. Clinically they had different cranial nerves dysfunction. Imaging showed jugular foramen tumor extending from posterior fossa to almost common carotid bifurcation at neck in both cases. Near total microsurgical excisions of the tumor were done through retrosigmoid suboccipital plus transmastoid high cervical approach with facial nerve mobilization in one case and without mobilization in other case. In case 1 combination of lower cranial nerve palsies is unique with inclusion of VIII nerve and that does not belong to any of the jugular foramen syndromes (i.e. Vernet, Collet- Sicard, Villaret, Tapia, Schmidt, and Jackson). Here IX, X, XI, XII and VIII cranial palsies was present (i.e.Collet-Sicard syndrome plus VIII nerve syndrome!). In the second case there was IX & X dysfunction with VIII dysfunction. We also went through the short review of the literature here DOI: http://dx.doi.org/10.3329/bjo.v18i2.12015 Bangladesh J Otorhinolaryngol 2012; 18(2): 183-192

Bitemporal compression injury caused by static loading mechanism

1985 ◽  
Vol 62 (3) ◽  
pp. 438-441 ◽  
Author(s):  
Kouhei Echizenya ◽  
Masaharu Satoh ◽  
Tango Nakagawa ◽  
Mitsuyuki Koiwa ◽  
Hiroshi Abe
Keyword(s):  
Static Loading ◽  
Head Injuries ◽  
Cranial Nerves ◽  
Sympathetic Nerves ◽  
Middle Cranial Fossa ◽  
Compression Injury ◽  
Content Type ◽  
Disturbance Of Consciousness ◽  
Cranial Nerve Injuries ◽  
Base Of The Skull

✓ The authors report two cases of bitemporal compression injury caused by a static loading mechanism. These head injuries resulted from gradual bitemporal compression of the head. Plain skull films showed multiple skull fractures, and carotid angiography revealed internal carotid artery obstruction at the base of the skull. Neurological examination disclosed a slight disturbance of consciousness, hemiparesis, multiple cranial nerve injuries, and Horner's syndrome. In comparison with impact head injury, the energy from this type of trauma tends to be transmitted to the foramina and hiati of the middle cranial fossa and results in multiple injuries to the cranial nerves, sympathetic nerves, and blood vessels.

The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children

1995 ◽  
Vol 83 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Andrew T. Dailey ◽  
Guy M. McKhann ◽  
Mitchel S. Berger
Keyword(s):  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Posterior Fossa Tumors ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Cranial Nerve Function ◽  
Pharyngeal Musculature ◽  
Fine Print

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

2000 ◽  
Vol 93 (4) ◽  
pp. 586-593 ◽  
Author(s):  
Johann Romstöck ◽  
Christian Strauss ◽  
Rudolf Fahlbusch
Keyword(s):  
Detailed Analysis ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Operative Procedure ◽  
Cranial Nerves ◽  
Postoperative Outcome ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Lower Cranial Nerves ◽  
Fine Print

Object. Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance.Methods. Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes.Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train—a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals—was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients).Conclusions. It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.

scholarly journals Neuroendocrine Carcinoma of the Jugular Foramen

2008 ◽  
Vol 87 (2) ◽  
pp. 86-91 ◽  
Author(s):  
John P. Leonetti ◽  
Mobeen A. Shirazi ◽  
Sam Marzo ◽  
Douglas Anderson
Keyword(s):  
Neuroendocrine Carcinoma ◽  
Vocal Fold ◽  
Cranial Nerves ◽  
Intensity Modulated Radiation Therapy ◽  
Jugular Foramen ◽  
Concurrent Chemotherapy ◽  
Lower Cranial Nerve ◽  
Nerve Preservation ◽  
Pathologic Features ◽  
Cranial Nerve Preservation

We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.

Intracranial ceruminous gland adenocarcinoma

1981 ◽  
Vol 55 (6) ◽  
pp. 952-956 ◽  
Author(s):  
John M. Cilluffo ◽  
Stephen G. Harner ◽  
Ross H. Miller
Keyword(s):  
Middle Ear ◽  
Clinical Course ◽  
Obstructive Hydrocephalus ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Clinical Findings ◽  
Cerebellar Hemisphere ◽  
Facial Paresis ◽  
Content Type ◽  
Slow Growing

✓ Patients with adenocarcinoma of the ceruminous gland arising in the middle ear have a typical syndrome consisting of unilateral hearing loss, otalgia, facial paresis, and a middle-ear mass. Adjacent cranial nerves also may be affected. Some patients may have an ipsilateral cerebellar ataxia if the lesion extends into the cerebellopontine angle and compresses the cerebellar hemisphere. Obstructive hydrocephalus may occur secondary to obstruction of the aqueduct or fourth ventricle. The initial clinical findings may be those of a jugular foramen syndrome. These lesions are usually slow-growing and may be associated with a very prolonged clinical course. Although the tumors are rare, the physician should be aware of their existence if proper care is to be given.

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.

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