RESUMO
PURPOSE: This study aims to assess the anatomical possibilities of the jugular bulb (JB). METHODS: Fifty archived CBCT scans were analyzed. RESULTS: The average distance between the internal acoustic canal (IAC) and the JB was 7.97 mm on both sides (Right: SD = 2.56 mm, range 3.16-13.3 mm; Left: SD = 2.5 mm, range 2.9-13.6 mm). JB walls' pneumatization was classified into eight patterns. Deep petrosal cells (DPCs) prevailed in the lateral wall of the JB. The absence of pneumatization (NP) was commonly found on the left side. The presence of infralabyrinthine and hypotympanic cells varied. Less common types included accessory occipital cells (AOCs), posteromedial tracts (PMTs), and basi-occipital cells (BOCs), which determined a consistent variation of the lateral wall pneumatization patterns. Pneumatization of the medial wall was not observed in 50 right sides and 49 left sides. The inferior wall analysis revealed symmetry in AOC distribution and a predominant occurrence of NP. Cases with hypotympanum (HT) in the lateral wall showed a statistically significant IAC-JB distance increase by an average of 4.67 mm compared to NPs. Specific pneumatizations, particularly HT on the lateral side, have a significant effect on the IAC-JB distance, showing a clear pattern of increasing distance from DPC to NP and then to HT. A significant distance increase in HT pneumatization was noted. There were also recorded instances of JB hypoplasia and hyperplasia, JB diverticula, dehiscent JBs, and high JBs. CONCLUSION: This study establishes a novel classification of JB pneumatizations to aid in the understanding of the temporal bone anatomy.
Assuntos
Variação Anatômica , Tomografia Computadorizada de Feixe Cônico , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/anatomia & histologia , Adolescente , Adulto Jovem , Forâmen Jugular/anatomia & histologia , Forâmen Jugular/diagnóstico por imagem , Idoso de 80 Anos ou mais , Estudos RetrospectivosRESUMO
OBJECTIVE: We compared the diameter of the jugular foramen (JF) between normal individuals and those with a diagnosis of craniovertebral junction abnormalities, such as Chiari malformation type I (CMI) and/or basilar invagination (BI). METHODS: This cross-sectional analytical study measured the diameter of the right and left JF on magnetic resonance imaging scans of patients divided into 4 groups: 68 with combined CMI and BI (CMI+BI), 42 with isolated BI, 45 with isolated CMI, and 102 control cases. The t test determined sex differences, and univariate analysis of variance with Tukey's post hoc test assessed JF differences between groups. RESULTS: Considering all combinations of laterality and sex, the CMI+BI group had a JF narrower than their respective control groups. The JF was bilaterally narrower in the BI group than in the control group only in the women. Regardless of laterality, the CMI group had a wider JF than did the CMI+BI group in men and did not differ from that of the control group. In the female patients with CMI, the right JF did not differ from that of the controls and was wider than that in the CMI+BI group. Also, the left JF was narrower than that in the control group and did not differ from that in the CMI+BI group. CONCLUSIONS: JF narrowing is associated with CMI and BI when combined in the same patient. When CMI or BI are detected separately, they do not imply evident changes in JF morphometry. It is expected that these findings could bring empiric substrate to support theories that claim a possible role of intracranial pressure disturbances as a triggering factor for CMI.
Assuntos
Malformação de Arnold-Chiari , Forâmen Jugular , Imageamento por Ressonância Magnética , Humanos , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/complicações , Feminino , Masculino , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Forâmen Jugular/diagnóstico por imagem , Adulto Jovem , Platibasia/complicações , Platibasia/diagnóstico por imagem , Adolescente , Constrição Patológica/diagnóstico por imagem , Idoso , CriançaRESUMO
OBJECTIVE: To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF) stenosis may determine dural venous sinus alterations and increased venous outflow resistance as main pathophysiological factor. METHODS: Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls. RESULTS: Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm2 vs. 57.5 + 20.7 mm2, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019). CONCLUSION: In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.
Assuntos
Hidrocefalia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Constrição Patológica/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Forâmen Jugular/diagnóstico por imagem , Angiografia por Ressonância Magnética , Estudos de Casos e ControlesRESUMO
A chronic cough, gag, or retch is a common presenting clinical complaint in dogs. Those refractory to conservative management frequently undergo further diagnostic tests to investigate the cause, including CT examination of their head, neck, and thorax for detailed morphological assessment of their respiratory and upper gastrointestinal tract. This case series describes five patients with CT characteristics consistent with an intracranial and jugular foraminal mass of the combined glossopharyngeal (IX), vagus (X), and accessory (XI) cranial nerves and secondary features consistent with their paresis. The consistent primary CT characteristics included an intracranial, extra-axial, cerebellomedullary angle, and jugular foraminal soft tissue attenuating, strongly enhancing mass (5/5). Secondary characteristics included smooth widening of the bony jugular foramen (5/5), mild hyperostosis of the petrous temporal bone (3/5), isolated severe atrophy of the ipsilateral sternocephalic, cleidocephalic, and trapezius muscles (5/5), atrophy of the ipsilateral thyroarytenoideus and cricoarytenoideus muscles of the vocal fold (5/5), and an ipsilateral "dropped" shoulder (4/5). Positional variation of the patient in CT under general anesthesia made the "dropped" shoulder of equivocal significance. The reported clinical signs and secondary CT features reflect a unilateral paresis of the combined cranial nerves (IX, X, and XI) and are consistent with jugular foramen syndrome/Vernet's syndrome reported in humans. The authors believe this condition is likely chronically underdiagnosed without CT examination, and this case series should enable earlier CT diagnosis in future cases.
Assuntos
Doenças do Cão , Nervo Glossofaríngeo , Forâmen Jugular , Tomografia Computadorizada por Raios X , Nervo Vago , Animais , Cães , Feminino , Nervo Acessório/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/veterinária , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Nervo Glossofaríngeo/diagnóstico por imagem , Forâmen Jugular/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Nervo Vago/diagnóstico por imagem , Doenças do Nervo Vago/veterinária , Doenças do Nervo Vago/diagnóstico por imagem , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/patologia , Estudos RetrospectivosRESUMO
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE: This approach is intended for tumors centered in the jugular foramen with extensions between intracranial and extracranial spaces, possible spread to the middle ear, and variable bony destruction. 1,2. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT: Jugular foramen paragangliomas are complex lesions that usually invade and fill related venous structures. They present complex relationships with skull base neurovascular structures as internal carotid artery, lower cranial nerves (CNs), middle ear, and mastoid segment of facial nerve. In this way, it is essential to perform an adequate preoperative vascular study to evaluate sinus patency and the tumor blood supply, besides a computed tomography scan to depict bone erosion. ESSENTIAL STEPS OF THE PROCEDURE: Mastoidectomy through an infralabyrinthine route up to open the lateral border of jugular foramen, allowing exposure from the sigmoid sinus to internal jugular vein. Skeletonization of facial canal without exposure of facial nerve is performed and opening of facial recess to give access to the middle ear in way of a fallopian bridge technique. 2-10. PITFALLS/AVOIDANCE OF COMPLICATIONS: If there is preoperative preservation of lower CN function, it is important to not remove the anteromedial wall of the internal jugular vein and jugular bulb. In addition, facial nerve should be exposed just in case of preoperative facial palsy to decompress or reconstruct the nerve. VARIANTS AND INDICATIONS FOR THEIR USE: Variations are related mainly with temporal bone drilling depending on the extensions of the lesion, its source of blood supply, and preoperative preservation of CN function.Informed consent was obtained from the patient for the procedure and publication of his image.Anatomy images were used with permission from:⢠Ceccato GHW, Candido DNC, and Borba LAB. Infratemporal fossa approach to the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.⢠Ceccato GHW, Candido DNC, de Oliveira JG, and Borba LAB. Microsurgical Anatomy of the Jugular Foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.
Assuntos
Tumor do Glomo Jugular , Forâmen Jugular , Humanos , Forâmen Jugular/diagnóstico por imagem , Forâmen Jugular/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Base do Crânio/anatomia & histologia , Tumor do Glomo Jugular/cirurgia , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia , Nervos CranianosRESUMO
BACKGROUND: Tumors involving the jugular foramen region are challenging for surgical resection. With the development of endoscope in the past decade, surgical approaches assisted by endoscope have been widely emerged in the treatment of skull base tumors. METHODS: Herein, we report a case of jugular foramen schwannoma (Samii type B). Surgical resection was applied via a suboccipital retrosigmoidal craniotomy using surgical microscope assisted by endoscope. Gross total resection was achieved. And the patient recovered without obvious neurological deficits. CONCLUSIONS: Samii type B schwannomas involving the jugular foramen is approachable by endoscope-assisted surgery.
Assuntos
Neoplasias de Cabeça e Pescoço , Forâmen Jugular , Neurilemoma , Neoplasias da Base do Crânio , Humanos , Forâmen Jugular/diagnóstico por imagem , Forâmen Jugular/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Neoplasias da Base do Crânio/patologia , Endoscopia , Craniotomia , Neoplasias de Cabeça e Pescoço/cirurgia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neurilemoma/patologiaRESUMO
BACKGROUND: Surgical treatment of dumbbell jugular foramen schwannomas can be challenging. The main goals of surgery are maximal resection with preservation of function and overall patient quality of life. METHODS: In this paper, we present a step-by-step technical description of a microsurgical resection of dumbbell-shaped JF schwannoma using a modified retrosigmoid infra-jugular approach. CONCLUSION: The modified retrosigmoid infra-jugular is a safe and suitable approach in selected cases. This technique, however, must be limited only to those tumors with minimal extension into the jugular foramen.
Assuntos
Forâmen Jugular , Neurilemoma , Humanos , Forâmen Jugular/diagnóstico por imagem , Forâmen Jugular/cirurgia , Qualidade de Vida , Procedimentos Neurocirúrgicos/métodos , Microcirurgia/métodos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neurilemoma/patologiaRESUMO
BACKGROUND: Among the several approaches described to the jugular foramen (JF), the retrosigmoid infralabyrinthine (suprajugular) approach was one of the most recently described. OBJECTIVE: To describe the indications, limitations, and operative nuances of the suprajugular approach. METHODS: We provided a pertinent review of the anatomy, indications, preoperative evaluation, surgical steps and nuances, and postoperative management. RESULTS: The suprajugular approach is suitable for tumors occupying the intracranial compartment with limited extension into the JF. Volume, width, and configuration of the foramen dictate the feasibility of the approach. Tumors invading the venous system are not suitable for this approach. Preoperative 3-dimensional MRI and computed tomography are used to evaluate intrajugular extension, relationship between the tumor and the jugular bulb (JB), venous system invasion, and shape of the JF. During surgery, exposition of the entire posterior border of the sigmoid sinus is needed and removing the bone over the JB. After identification of the JF, the jugular notch and intrajugular process of the roof of the foramen are removed and intrajugular resection is completed. In cases of high-riding JB, it may be gently pushed down to allow visualization of the anterior foramen. In cases of JB laceration, it may be repaired using a muscle patch and usually does preclude further resection. CONCLUSION: The suprajugular approach is variation of the retrosigmoid approach that, when properly indicated, provides excellent exposure of the medial JF, with most anatomical variations and intraoperative complications predicted by a comprehensive preoperative evaluation.
Assuntos
Forâmen Jugular , Humanos , Forâmen Jugular/diagnóstico por imagem , Forâmen Jugular/cirurgiaRESUMO
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.
Assuntos
Circulação Colateral , Forâmen Jugular/diagnóstico por imagem , Veias Jugulares/anormalidades , Angiografia por Ressonância Magnética/métodos , Flebografia/métodos , Trombose/complicações , Malformações Vasculares/diagnóstico , Adolescente , Adulto , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Trombose/diagnóstico , Malformações Vasculares/complicaçõesRESUMO
Clarifying temporal changes in magnetic resonance imaging (MRI) offers a good chance to understand the pathology of neural lesions; however, such information is scarce in varicella zoster virus (VZV) neuropathies for the glossopharyngeal and vagus nerves. Here, we present the changes in sequential MR images of such a pathology over a period of 12 months from symptom onset.A 27-year-old woman with difficulty in swallowing and hoarseness due to a palatal palsy and arytenoid fixation on the left presented 2 days after onset. MRI revealed a lesion which largely filled the left jugular foramen on T2-weighted images (T2-WI) with high diffusion-weighted imaging (DWI) signals, which has never been previously described, on the 3rd day after onset. The DWI signals were highest on day 3, then deteriorated over 2 months until the signal was only detectable at the intracranial level, but not in the jugular foramen. The glossopharyngeal nerve had returned to normal by 2 months.The time course of the glossopharyngeal and vagus nerve swelling detected on T2-WI suggests that nerve swelling reduces over several months, even though the paralytic symptoms persist. Furthermore, the high DWI signal suggests that nerve swelling was caused by edematous swelling of the nerve fibers, rather than fiber disruption with water displacement in the extracellular space. These findings may provide good clues to speculate on the dynamically changing pathology of VZV neuropathies of the glossopharyngeal and vagus nerves.
Assuntos
Doenças do Nervo Glossofaríngeo/diagnóstico por imagem , Doenças do Nervo Glossofaríngeo/virologia , Doenças do Nervo Vago/diagnóstico por imagem , Doenças do Nervo Vago/virologia , Infecção pelo Vírus da Varicela-Zoster/diagnóstico por imagem , Adulto , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Forâmen Jugular/diagnóstico por imagem , Neuroimagem/métodos , Infecção pelo Vírus da Varicela-Zoster/patologiaRESUMO
OBJECTIVE: This study aims to provide morphometric analysis of endoscopic endonasal approach (EEA) to the ventral-medial portion of posterior paramedian skull base. Furthermore, it aims to investigate the surgical exposure obtained through EEA with and without eustachian tube (ET) removal, emphasizing the role of contralateral nostril (CN) access. METHODS: Five fresh adult head specimens were prepared for dissection. A predissection and a postdissection computed tomography study was performed. A surgically oriented classification into 4 regions was used: 1) tubercular region; 2) occipital condyle region; 3) parapharyngeal space (PPhS) region; and 4) jugular foramen (JF) region. The Student t-test was used to compare angulations and measures of EEA with access from the ipsilateral and CN, respectively, with and without ET removal. RESULTS: EEA to the ventral-medial portion of posterior paramedian skull base encompasses 2 medial trajectories (transtubercular and transcondylar) and 2 lateral pathways to the PPhS and JF. The CN access, without removal of the ET, allows a complete exposure of the petrous and intrajugular portion of the JF and superior PPhS without exposition of the parapharyngeal segment of internal carotid artery. The ipsilateral nostril approach with ET removal allows to obtain a wider exposure, reaching the medial sigmoid part of the JF. No significant differences exist in regard to transtubercular and transcondylar approaches. CONCLUSIONS: This study suggests that EEA to posterior paramedian skull base allows the realization of a corridor directed to the jugular tubercle, occipital condyle, medial PPhS, and ventral-medial JF. The CN approach with ET preservation can expose the petrous and intrajugular parts of the JF and PPhS. Case series are needed to demonstrate benefits and drawbacks of these approaches.
Assuntos
Tuba Auditiva/cirurgia , Forâmen Jugular/cirurgia , Neuroendoscopia , Osso Occipital/cirurgia , Espaço Parafaríngeo/cirurgia , Base do Crânio/cirurgia , Cadáver , Dissecação , Tuba Auditiva/anatomia & histologia , Tuba Auditiva/diagnóstico por imagem , Humanos , Forâmen Jugular/anatomia & histologia , Forâmen Jugular/diagnóstico por imagem , Cavidade Nasal/anatomia & histologia , Cavidade Nasal/diagnóstico por imagem , Cirurgia Endoscópica por Orifício Natural , Osso Occipital/anatomia & histologia , Osso Occipital/diagnóstico por imagem , Espaço Parafaríngeo/anatomia & histologia , Espaço Parafaríngeo/diagnóstico por imagem , Base do Crânio/anatomia & histologia , Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND PURPOSE: The transverse sinus (TS) is a frequent location of cerebral venous thrombosis. However, unilateral TS hypoplasia is a frequent variation and radiological imaging pitfall in the diagnosis because it may mimic unilateral TS thrombosis. The purpose of this study is to find a cutoff value for bilateral jugular foramen (JF) diameter ratios on magnetic resonance imaging (MRI) for differentiating TS thrombosis from TS hypoplasia. MATERIALS AND METHODS: We retrospectively reviewed magnetic resonance venography results for 174 patients with reduced unilateral TS caliber resulting from either unilateral thrombosis (80 patients) or unilateral hypoplasia (94 patients). We calculated the ratio by proportioning the diameter of the JF ipsilateral to the TS with caliber reduction to the diameter of the contralateral JF. The Mann-Whitney U test was used to compare the ratios between thrombosis and hypoplasia groups, and the cutoff value was calculated by receiver-operating characteristic curve analysis. RESULTS: The ratio of bilateral JF diameters was lower in patients with hypoplasia than those with thrombosis (P < .01). The cutoff value to determine the diagnosis of TS hypoplasia with maximum accuracy was 0.638, with a sensitivity of 91.3% and specificity of 64.9%. CONCLUSION: In equivocal cases, calculating the cutoff value by proportioning the diameter of JF ipsilateral to the TS with caliber reduction to the contralateral JF seems to be an efficient, quick, and straightforward method and valuable aid to differentiate TS thrombosis from TS hypoplasia.
Assuntos
Forâmen Jugular/diagnóstico por imagem , Trombose do Seio Lateral/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Seios Transversos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Forâmen Jugular/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Valores de Referência , Estudos Retrospectivos , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Seios Transversos/anormalidades , Adulto JovemRESUMO
OBJECTIVES: To present a novel location in which neurosarcoidomatous inflammation is identified and its accompanying presentation. METHODS: The authors present a case of bilateral vocal fold paresis associated with non-caseating granulomatous inflammation of the cervical and intra-axial portions of the vagus nerve masquerading as a cranial nerve tumor. RESULTS: Examination revealed bilateral vocal fold paresis and asymmetric palate elevation. MRI demonstrated enhancing bilateral jugular foramen masses, and neck ultrasound demonstrated bilateral thickened appearance of the vagus nerves. Vagus nerve biopsy demonstrated non-caseating granulomas. CONCLUSIONS: Neurosarcoidosis may contribute to variable cranial neuropathies. Vocal fold paresis is usually thought to arise from mediastinal compression of the left recurrent laryngeal nerve. Rarely, though, lesions may arise in other parts of the vagus nerve. Failure of response to steroids does not rule out the diagnosis, making tissue diagnosis important in some cases.
Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Sarcoidose/diagnóstico , Nervo Vago/diagnóstico por imagem , Nervo Vago/patologia , Paralisia das Pregas Vocais/etiologia , Biópsia , Feminino , Granuloma/diagnóstico por imagem , Granuloma/etiologia , Humanos , Forâmen Jugular/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , UltrassonografiaRESUMO
OBJECTIVE: To describe the morphology and anatomical relationship of the jugular process (JP) and to elucidate its utility as a surgical landmark in the lateraland posterior lateral approaches to the jugular foramen. MATERIALS AND METHODS: Eight dry adult skulls and 10 silicon-injected cadaver heads were used for this study. The distances to selected structures and the thickness of the JP at 3 selected sites were measured. We also included the data of 20 thin-sliced 3-dimensional computed tomography scans. The radiology data of these patients were transferred to a workstation for 3-dimensional reconstruction. RESULTS: The JP, an irregular trapezoid structure, is an important surgical landmark when approaching the jugular foramen. Laterally the JP is rough with 1 or 2 prominences to which the rectus capitis lateralis is attached. The JP is relatively flat medially. The condylar part of the occipital bone could be conceived as a "3-story building." The JP, hypoglossal canal, and lateral and posterior condylar emissary veins are located on the middle floor. The stylomastoid foramen is found constantly in the triangle formed by the styloid process, JP, and the base of the mastoid process. CONCLUSIONS: The JP is an important surgical landmark in the identification of jugular foramen, especially in the lateral and posterior approaches. A better understanding of its morphology and its relationship with the surrounding structures is a prerequisite for accurate surgical planning and intraoperative orientation.
Assuntos
Pontos de Referência Anatômicos , Forâmen Jugular/anatomia & histologia , Osso Occipital/anatomia & histologia , Adulto , Neoplasias Encefálicas/patologia , Cadáver , Feminino , Perda Auditiva/etiologia , Humanos , Imageamento Tridimensional , Forâmen Jugular/diagnóstico por imagem , Imageamento por Ressonância Magnética , Microcirurgia/métodos , Neuroma Acústico/patologia , Osso Occipital/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Complete resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve complications remains difficult even for skilled neurosurgeons. Between November 2011 and November 2017, 31 consecutive patients diagnosed with JFSs underwent a single-stage operation performed by the same neurosurgeon. We retrospectively analyzed clinical characteristics, surgical approaches, treatment outcomes, and follow-up data for these patients. JFSs were classified according to the Samii classification system. A retrosigmoid approach was used to resect type A tumors, while a suboccipital transjugular process (STJP) approach was used to resect type B tumors. Notably, the present study is the first to report the use of a paracondylar-lateral cervical (PCLC) approach for the treatment of type C and D tumors. Type A-D tumors were observed in seven, four, four, and 16 patients, respectively. Gross-total resection was achieved in 29 patients (93.5%). There were no cases of intracranial hematoma, re-operation, tracheotomy, or death. Adjunctive gamma knife treatment was used to manage residual tumors in two patients. Neurological deficits relieved in half of patients at the last follow-up. By reviewing the studies published on PubMed, the approaches gradually be more conservative, rather than widely expose the skull base. Nonetheless, endoscope and stereotactic radiosurgery plays an important role in the management of JFSs. Both tumor removal and neurological function retention can be obtained by choosing individual treatment.
Assuntos
Forâmen Jugular/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Craniotomia/métodos , Feminino , Seguimentos , Humanos , Forâmen Jugular/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/cirurgia , Doenças do Sistema Nervoso/etiologia , Neurilemoma/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
Jugular foramen schwannomas (JFSs) are relatively rare, benign lesions that account for 10% to 30% of all tumors in the region of the jugular foramen. Given their slow-growing nature, JFSs can become quite large before causing symptoms of lower cranial nerve (LCN) dysfunction, making microsurgical resection a challenge. Successful resection of any JFS is dependent on the identification and preservation of the adjacent, uninvolved LCNs to alleviate nerve compression and preserve function. We report a transmastoid, high cervical approach to a dumbbell-shaped, extracranial JFS that was causing symptomatic LCN compression. The patient presented with dysphagia and was found to have left vocal cord paralysis on video laryngoscopy and intermittent aspiration on a swallowing evaluation. The transmastoid, high cervical exposure allowed for early identification of the tumor as well as the adjacent LCNs. Neurophysiological monitoring included somatosensory evoked potentials; brainstem auditory evoked responses; and cranial nerve VII, X, XI, and XII electromyographic monitoring. Endoscopic assistance allowed for improved LCN visualization from the high cervical exposure and gross-total resection of the tumor. The patient's dysphagia improved both subjectively and objectively following the resection. The patient gave written informed consent for surgery and publication of the case report. Institutional review board approval was not required for this case report. Used with permission from Barrow Neurological Institute.
Assuntos
Vértebras Cervicais/cirurgia , Transtornos de Deglutição/cirurgia , Forâmen Jugular/cirurgia , Processo Mastoide/cirurgia , Neurilemoma/cirurgia , Neuroendoscopia/métodos , Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Humanos , Forâmen Jugular/diagnóstico por imagem , Processo Mastoide/diagnóstico por imagem , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagemAssuntos
Forâmen Jugular , Imageamento por Ressonância Magnética , Mieloma Múltiplo , Plasmocitoma , Neoplasias da Base do Crânio , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Forâmen Jugular/diagnóstico por imagem , Forâmen Jugular/patologia , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/metabolismo , Mieloma Múltiplo/patologia , Mieloma Múltiplo/terapia , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/metabolismo , Plasmocitoma/patologia , Plasmocitoma/terapia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/metabolismo , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/terapiaRESUMO
BACKGROUND: The jugular process forms the posteroinferior surface of the jugular foramen and is an important structure for surgical approaches to the foramen. However, its morphological features have not been well described in modern texts. OBJECTIVE: To elucidate the microsurgical anatomy of the jugular process and examine its morphological features. METHODS: Five adult cadaveric specimens were dissected in a cadaveric study, and computed tomography data from 31 heads (62 sides) were examined using OsiriX (Pixmeo SARL, Bernex, Switzerland) to elucidate the morphological features of the jugular process. RESULTS: The cadaveric study showed that it has a close relationship with the sigmoid sinus, jugular bulb, rectus capitis lateralis, lateral atlanto-occipital ligament, and lateral and posterior condylar veins. The radiographic study showed that 9/62 sigmoid sinuses protruded inferiorly into the jugular process and that in 5/62 sides, this process was pneumatized. At the entry of the jugular foramen, if the temporal bone has a bulb-type jugular bulb, and if surgery concerns the right side of the head, the superior surface of the jugular process is more likely to be steep. CONCLUSION: The jugular process forms the posteroinferior border of the jugular foramen. Resection of the jugular process is a critical step for opening the jugular foramen from the posterior and lateral aspects. Understanding the morphological features of the jugular process, and preoperative and radiographical examination of this process thus help skull base surgeons to access the jugular foramen.