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.

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 transmastoid posterior petrosal approach for locally aggressive tumors in the petrous part of the temporal bone involving the internal auditory canal, jugular foramen, and hypoglossal canal

2020 ◽  
Vol 133 (4) ◽  
pp. 1248-1260
Author(s):  
Masahiro Shin ◽  
Hirotaka Hasegawa ◽  
Satoru Miyawaki ◽  
Akinobu Kakigi ◽  
Tsuguto Takizawa ◽  
...  
Keyword(s):  
Skull Base ◽  
Internal Carotid ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Jugular Foramen ◽  
Occipital Condyle ◽  
Skull Base Tumors ◽  
Hypoglossal Canal ◽  
Air Cells ◽  
Mastoid Air Cells

OBJECTIVEThe posterior petrosal approach is an established surgical method offering wide access to skull base lesions through mastoid air cells. The authors describe their experience with the endoscopic transmastoid “posterior petrosal” approach (EPPAP) for skull base tumors involving the internal auditory canal (IAC), jugular foramen, and hypoglossal canal.METHODSThe EPPAP was performed for 7 tumors (3 chordomas, 2 chondrosarcomas, 1 schwannoma, and 1 solitary fibrous tumor). All surgical procedures were performed under endoscopic visualization with mastoidectomy. The compact bone of the mastoid air cells and posterior surface of the petrous bone are carefully removed behind the semicircular canals. When removal of cancellous bone is extended superomedially through the infralabyrinthine space, the surgeon can expose the IAC and petrous portion of the internal carotid artery to reach the petrous apex (infralabyrinthine route). When removal of cancellous bone is extended inferomedially along the sigmoid sinus, the surgeon can safely reach the jugular foramen (transjugular route). Drilling of the inferior surface of petrous bone is extended further inferoposteriorly behind the jugular bulb to approach the hypoglossal canal and parapharyngeal space through the lateral aspect of the occipital condyle (infrajugular route).RESULTSOf the 7 tumors, gross-total resection was achieved in 4 (57.1%), subtotal resection (> 95% removal) in 2 (28.6%), and partial resection (90% removal) in 1 (14.2%). Postoperatively, 2 of 3 patients with exudative otitis media showed improvement of hearing deterioration, as did 2 patients with tinnitus. Hypoglossal nerve palsy and swallowing difficulty were improved after surgery in 2 patients and 1 patient, respectively. In 1 patient with severe cranial nerve deficits before surgery, symptoms did not show any improvement.CONCLUSIONSThe authors present their preliminary experience with EPPAP for skull base tumors in the petrous part of the temporal bone and the lateral part of the occipital condyle involving the cranial nerves and internal carotid arteries. The microscope showed a higher-quality image and illumination in the low-power field. However, the endoscope could offer wider visualization of the surgical field and contribute to minimizing the size of the surgical pathways, necessity of brain retraction, and eventually the invasiveness of surgery. Thus, the EPPAP may be safe and effective for skull base tumors in the petrous region, achieving balance between the radicality and invasiveness of the skull base surgery.

Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach

1997 ◽  
Vol 87 (4) ◽  
pp. 555-585 ◽  
Author(s):  
Hung T. Wen ◽  
Albert L. Rhoton ◽  
Toshiro Katsuta ◽  
Evandro de Oliveira
Keyword(s):  
Jugular Foramen ◽  
Lateral Approach ◽  
Occipital Bone ◽  
Occipital Condyle ◽  
Microsurgical Anatomy ◽  
Posterior Portion ◽  
Hypoglossal Canal ◽  
Transcondylar Approach ◽  
Far Lateral Approach ◽  
Far Lateral

✓ Despite a large number of reports of the use of the far-lateral approach, some of the basic detail that is important in safely completing this exposure has not been defined or remains poorly understood. The basic far-lateral exposure provides access for the following approaches: 1) the transcondylar approach directed through the occipital condyle or the adjoining portions of the occipital and atlantal condyles; 2) the supracondylar approach directed through the area above the occipital condyle; and 3) the paracondylar exposure directed through the area lateral to the occipital condyle. The transcondylar approach provides access to the lower clivus and premedullary area. The supracondylar approach provides access to the region of, and medial to, the hypoglossal canal and jugular tubercle. The paracondylar approach, which includes drilling of the jugular process of the occipital bone in the area lateral to the occipital condyle, provides access to the posterior portion of the jugular foramen and to the mastoid on the lateral side of the jugular foramen. In this study, the anatomy important to completing the far-lateral approach and these modifications was examined in 12 cadaveric specimens. In the standard posterior and posterolateral approaches, an understanding of the individual suboccipital muscles is not essential. However, these muscles provide important landmarks for the far-lateral approach and its modifications. Other important considerations include the relationship of the occipital condyle to the foramen magnum, hypoglossal canal, jugular tubercle, the jugular process of the occipital bone, the mastoid, and the facial canal. These and other relationships important to completing these exposures were examined in this study.

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.

Solitary Paraganglioma of the Hypoglossal Nerve: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. E1170-E1174 ◽  
Author(s):  
Kazim Raza ◽  
Chandrasekaran Kaliaperumal ◽  
Michael Farrell ◽  
John A. O'Dwyer ◽  
Christopher Pidgeon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hypoglossal Nerve ◽  
Jugular Foramen ◽  
Low Grade ◽  
Resonance Imaging ◽  
Stereotactic Radiation ◽  
Hypoglossal Canal ◽  
Suboccipital Craniotomy ◽  
History Of

Abstract BACKGROUND AND IMPORTANCE: We report the case history of solitary hypoglossal paraganglioma in a 64-year-old woman. The surgical difficulties encountered in the removal of this challenging tumor are discussed and as a literature review provided. CLINICAL PRESENTATION: A 64-year-old woman presented with a short history of dysphonia, occasional dysphagia, tinnitus, altered taste, and unilateral left-sided tongue wasting. On examination, there was left lower motor hypoglossal paralysis. Imaging showed a discrete enhancing lobulated mass, measuring 2 × 2 cm, in the region of the hypoglossal nerve extending into the hypoglossal canal suggestive of hypoglossal paraganglioma. A left dorsolateral suboccipital craniotomy was performed with the patient in the sitting position. The hypoglossal nerve appeared to be enlarged, and the jugular foramen was normal. Complete surgical debulking of the tumor was not attempted because of its vascular nature. The nerve was decompressed, and neuropathology confirmed a low-grade paraganglioma arising from the hypoglossal nerve. The patient was scheduled to receive stereotactic radiation for further management. CONCLUSION: When a case of solitary hypoglossal paraganglioma is encountered in clinical practice, the aim of management should be mainly focused on achieving a diagnosis and preserving the hypoglossal nerve function. If there is evidence of vascularity in the lesion noted on magnetic resonance imaging, a preoperative angiogram should be obtained with a view for embolization. We decompressed the hypoglossal canal and achieved good improvement in the patient's symptoms. We recommend stereotactic radiosurgery for remnant and small hypoglossal tumors and regular follow-up with magnetic resonance imaging scans.

Cancellous bone transplantation for the early-stage of Freiberg's disease

2017 ◽  
Vol 23 ◽  
pp. 66
Author(s):  
M. Kubota ◽  
K. Hattori ◽  
K. Minagawa ◽  
T. Kimura ◽  
H. Inoue ◽  
...  
Keyword(s):  
Cancellous Bone ◽  
Early Stage ◽  
Bone Transplantation ◽  
Freiberg’S Disease ◽  
Cancellous Bone Transplantation

scholarly journals Osteopontin Deficiency Induces Parathyroid Hormone Enhancement of Cortical Bone Formation

Endocrinology ◽  
2003 ◽  
Vol 144 (5) ◽  
pp. 2132-2140 ◽  
Author(s):  
Keiichiro Kitahara ◽  
Muneaki Ishijima ◽  
Susan R. Rittling ◽  
Kunikazu Tsuji ◽  
Hisashi Kurosawa ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Formation ◽  
Bone Mass ◽  
Cortical Bone ◽  
Cancellous Bone ◽  
Wild Type ◽  
Mineral Density ◽  
Cortical Bone Mass ◽  
Intermittent Pth

Intermittent PTH treatment increases cancellous bone mass in osteoporosis patients; however, it reveals diverse effects on cortical bone mass. Underlying molecular mechanisms for anabolic PTH actions are largely unknown. Because PTH regulates expression of osteopontin (OPN) in osteoblasts, OPN could be one of the targets of PTH in bone. Therefore, we examined the role of OPN in the PTH actions in bone. Intermittent PTH treatment neither altered whole long-bone bone mineral density nor changed cortical bone mass in wild-type 129 mice, although it enhanced cancellous bone volume as reported previously. In contrast, OPN deficiency induced PTH enhancement of whole-bone bone mineral density as well as cortical bone mass. Strikingly, although PTH suppressed periosteal bone formation rate (BFR) and mineral apposition rate (MAR) in cortical bone in wild type, OPN deficiency induced PTH activation of periosteal BFR and MAR. In cancellous bone, OPN deficiency further enhanced PTH increase in BFR and MAR. Analysis on the cellular bases for these phenomena indicated that OPN deficiency augmented PTH enhancement in the increase in mineralized nodule formation in vitro. OPN deficiency did not alter the levels of PTH enhancement of the excretion of deoxypyridinoline in urine, the osteoclast number in vivo, and tartrate-resistant acid phosphatase-positive cell development in vitro. These observations indicated that OPN deficiency specifically induces PTH activation of periosteal bone formation in the cortical bone envelope.

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