Jugular foramen and venous collaterals may help to discriminate congenital from post-thrombotic jugular stenosis

Purpose Unilateral jugular stenosis is easily mistaken as jugular hypoplasia for their similar jugular appearances. This study aimed to propose a scheme to differentiate acquired internal jugular vein stenosis (IJVS) from congenital jugular variation through two case examples. Methods We presented a dynamic evolution process of the IJVS formation, through a case of a 17-year-old female with paroxysmal nocturnal hemoglobinuria (PNH)-associated right internal jugular venous thrombosis (IJVT), which resulted in post-thrombotic IJVS in the rare context of rapid recanalization. Meanwhile, we compared her images with images of a 39-year-old healthy male with hypoplastic IJV to determine the differences between the acquired IJVS and congenital dysplasia. Results Based on the first case, we noticed the whole formative process of acquired IJVS from nothing to something. Meantime, we found that acquired IJVS was surrounded by abnormal corkscrew collaterals as imaged on contrast-enhanced magnetic resonance venography (CE-MRV), and the ipsilateral jugular foramen (JF) was normal-sized as displayed on computer tomography (CT). Conversely, jugular hypoplasia was with ipsilateral stenotic JF and without serpentine collaterals. Conclusion JF morphology and venous collaterals may be deemed as surrogate identifiers to distinguish acquired unilateral IJVS from jugular hypoplasia.

Surgical treatment of glossopharyngeal nerve schwannomas: Results of two-center study (14 patients included) and literature review

Objective: This study is aimed to analyze the outcomes of surgical treatment of glossopharyngeal schwannomas based on pre- and postoperative neurological status assessment. Materials and methods: This paper is a retrospective analysis of examination and surgical treatment of 14 patients who were operated on in two large clinics from 2018 to 2021 inclusive. When analyzing the collected data, gender, age, disease symptoms, tumor size and location, surgical approach, tumor to cranial nerves (CN) ratio, jugular foramen (JF) condition, and tumor removal volume were taken into account. All tumors were divided into groups depending on tumor location relative to the JF. Particular attention was paid to assessing cranial nerves functions. Facial nerve function was assessed as per House-Brackmann Scale (HBS), hearing function as per Gardner-Robertson Scale (GRS). Results: 3 (21.4%) patients had total tumor removal: 2 patients had type A tumors and one had type B tumor. Subtotal resection took place in 7 (50%) cases. In 4 cases, a tumor was partially removed: 3 patients had type D tumors and one had type B tumor. 3 (21.4%) patients had preoperative FN deficit (HBS Grade II) and mild dysfunction. 5 (35.7%) patients had postoperative facial nerve deficit: HBS ІІ, 2; ІІІ, 1; V, 2. Preoperative sensorineural type hearing impairment on the affected side was diagnosed in 13 (92.6%) patients. Before surgery, 6 patients had non-serviceable hearing, which remained at the same level after surgery. None of the patients with grade I or II hearing before surgery had any hearing impairment postoperatively. In 2 (14.3%) cases, hearing improved from grade V to grade III after surgery. 6 (42.9%) patients developed new neurological deficit in the caudal group CN. Postoperative deficit of the caudal group CN occurred in type D tumors in 3 patients, type A tumors 2 patients, and type B tumors one patient. Conclusions: Applying a retrosigmoid approach only makes it possible to achieve total tumor removal in case of type A tumors. To remove other tumor types, it is necessary to select approaches that enable access to the jugular foramen and infratemporal fossa. Intraoperative neurophysiological monitoring is an extremely important tool in glossopharyngeal schwannoma surgery. The most common postoperative complication is a developed or increased deficit of the caudal CN group, which can lead to persistent impairments in the patients’ quality of life. Preservation of the CN VII and VIII function in most cases is a feasible task and shall be ensured as a standard for this pathology.

An Enlarged Right Jugular Foramen

Jugular foramina are two openings in the base of the skull. Difference in diameter between two sides is noted, while right sided foramen is usually mentioned as the larger one. Rare cases have been reported with an enlarged jugular foramen. We report such a case with a right jugular foramen of a diameter 24mmX13mm. Microsurgery in the near future may exploid cases with greater openings. KEY WORDS: Base of the skull, Dry bone, Microsurgery.

Effect of Surgical Resection on Jugular Foramen Tumors: A Retrospective Study

The complex anatomical structure of jugular foramen (JF) makes a challenge for the diagnose and treatment of this region’s tumors. The purpose of the study was to investigate the effect of surgical resection in patients with JF tumors. A total of 77 patients with JF tumors treated with surgical resection between 2012 and 2021 were retrospectively reviewed. General characteristics, tumor classification, surgical approach and outcomes were retrospectively analyzed. The mean follow-up period was 4.5 years (ranging 0.5-8.5 years). Of the enrolled patients, 63 patients (81.82%) were diagnosed with JF schwannomas. 67 cases (87.01%) of the total patients received gross-total resection. Preoperatively, hoarseness and/or dysarthria served as the most complained symptoms (n=41, 53.25%), followed by swallowing disturbance (n = 37, 48.05%), hearing disturbance and/or tinnitus (n = 32, 41.56%). Postoperatively, a total of 52 patients (67.53%) were without significant symptoms. Worsened hoarseness and/or dysarthria symptoms were found in 14 patients (18.18%). Besides, 6 cases (7.79%) of the enrolled patients showed worsened swallowing disturbance. 8 patients (10.39%) presented with facial palsy after operation and 3 of them got improvement during the follow-up. Nine patients (12.68%) had tumor recurrence and there was one death (1.3%) associated with surgery during the perioperative period in the cohort. Therefore, surgical resection was an effective treatment of JF tumors with improvements of symptoms and good control of tumor. However, operation on this region was at the risks of worsening cranial nerve deficits and death, which needed advance in skull base surgery and rich experience.