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Ceccato GHW, Dos Santos Neto PH, de Oliveira JS, Schrenk WF, Cardoso LS, Carvalho ND, Coelho VN, Hasegawa HA, Bubicz JVR, Borba LAB. Microsurgical Resection of Dumbbell-Shaped Jugular Foramen Schwannoma Using the Transmastoid Presigmoid Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e82-e83. [PMID: 37133276 DOI: 10.1227/ons.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/25/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Guilherme H W Ceccato
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Pedro H Dos Santos Neto
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Júlia S de Oliveira
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Wesley F Schrenk
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Larissa S Cardoso
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Nick D Carvalho
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Vinicius N Coelho
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Hugo A Hasegawa
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Joao V R Bubicz
- School of Medicine, Positivo University, Curitiba, Paraná, Brazil
| | - Luis A B Borba
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Federal University of Paraná, Curitiba, Paraná, Brazil
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Di Vitantonio H, Tozzi A, De Paulis D, Millimaggi DF, Di Cola F, Raysi Dehcordi S, Galzio RJ, Ricci A. Extracranial Jugular Foramen Schwannomas Treated with the Extreme Lateral Juxtacondylar Approach: Surgical Technique and Our Experience. Oper Neurosurg (Hagerstown) 2023; 24:425-431. [PMID: 36701746 PMCID: PMC10158918 DOI: 10.1227/ons.0000000000000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Schwannoma that arises in the jugular foramen (JF) represents an important challenge for neurosurgeons for its precise location, extension, and neurovascular relationship. Nowadays, different managements are proposed. In this study, we present our experience in the treatment of extracranial JF schwannomas (JFss) with the extreme lateral juxtacondylar approach (ELJA). OBJECTIVE To present our experience in the treatment of extracranial JF schwannomas (JFss) with the ELJA. METHODS Between January 2013 and January 2017, 12 patients with extracranial JFs underwent surgery by ELJA. All lesions were type C of the Samii classification. Indocyanine green videoangiography was used to evaluate the relationship between the internal jugular vein and the tumor and to control the presence of spasm in the vertebral artery. RESULTS A complete exeresis was achieved in 9 patients while in 3 patients, it was subtotal. The complete regression of symptoms was obtained in 7 patients with a total resection. The remaining cases experienced a persistence of symptoms. CONCLUSION The success of this surgery is achieved through a management that starts from the patient's position. We promote an accurate evaluation of JFs through the Samii classification: Type C tumors allow the use of ELJA that reduces surgical complications. Furthermore, we recommend the use of indocyanine green videoangiography to preserve the vessels and prevent vasospasm.
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Affiliation(s)
| | - Alessandro Tozzi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | | | | | - Francesco Di Cola
- Operative Unit of Neurosurgery, San Salvatore City Hospital L'Aquila, Italy
| | - Soheila Raysi Dehcordi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Renato J. Galzio
- Operative Unit of Neurosurgery Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandro Ricci
- Operative Unit of Neurosurgery, San Salvatore City Hospital L'Aquila, Italy
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Giammattei L, Passeri T, di Russo P, Froelich S. Anterolateral (juxtacondylar) approach with limited mastoidectomy to resect a jugular foramen meningioma. Acta Neurochir (Wien) 2023; 165:1309-1314. [PMID: 36609565 DOI: 10.1007/s00701-022-05482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The anterolateral (juxtacondylar) approach with limited mastoidectomy is a suitable option to expose the postero-inferior part of the jugular foramen (JF). It is particularly indicated for tumors extending in the neck beyond the jugular foramen, especially in those cases necessitating both neck control as well as control of the mastoid segment of facial nerve. METHOD We describe here the steps to safely perform an anterolateral approach with mastoidectomy along with a brief description of its indications and limits. CONCLUSION This approach represents a valid option to reach the JF. Its knowledge can improve the process of optimal approach selection when dealing with complex pathology involving the JF.
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Affiliation(s)
- L Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Paris, France.
| | - T Passeri
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
| | - P di Russo
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
| | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, Paris, France.,University of Paris, Paris, France
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Cinibulak Z, Al-Afif S, Nakamura M, Krauss JK. Surgical treatment of selected tumors via the navigated minimally invasive presigmoidal suprabulbar infralabyrinthine approach without rerouting of the facial nerve. Neurosurg Rev 2022; 45:3219-3229. [PMID: 35739337 DOI: 10.1007/s10143-022-01825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
The feasibility of a novel skull base approach - the navigated minimally invasive presigmoidal suprabulbar infralabyrinthine approach (NaMIPSI-A) without rerouting of the fallopian canal for selected jugular foramen tumors (JFTs) - has been demonstrated in a neuroanatomical laboratory study. Here, we present our clinical experience with the NaMIPSI-A for selected JFTs, with a particular focus on its efficacy and safety. All patients with JFTs who were treated via the NaMIPSI-A were included in this study. The JFTs were classified according to a modified Fisch classification. The neurological and neuroradiological outcome, the extent of tumor resection, and the approach-related morbidity were examined. Five patients (two women, three men; mean age 57 years, range 48-65) were available. According to the modified Fisch classification, two JFTs were graded as C1, one as De1, and two as De2. Gross total resection (GTR) was achieved in three patients and near-total resection (NTR) in two. Postsurgically, no new neurological deficits and no approach-related morbidity and mortality occurred. One case with a postoperative cerebrospinal fluid leak was managed successfully with lumbar drainage. During the follow-up period (mean 67.6 months, range 12-119 months), tumor recurrence was noted in the NTR group but not in the GTR group. The NaMIPSI-A to the jugular foramen without rerouting of the fallopian canal is highly valuable for selected tumors of the jugular foramen. It is less invasive than other skull base approaches, and it allows safe and complete tumor removal in appropriate patients.
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Affiliation(s)
- Zafer Cinibulak
- Department of Neurosurgery, Merheim Hospital, Ostmerheimer Str. 200, 51109, Cologne, Germany. .,Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Shadi Al-Afif
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Merheim Hospital, Ostmerheimer Str. 200, 51109, Cologne, Germany.,Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
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Wang X, Liang J, Li M, Bai J, Tang J, Bao Y, Xiao X. Surgical treatment of dumbbell-shaped jugular foramen schwannomas via two-piece lateral suboccipital approach: Report of 26 patients. J Clin Neurosci 2021; 94:32-37. [PMID: 34863457 DOI: 10.1016/j.jocn.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dumbbell-shaped jugular foramen schwannomas (JFS) are rare but challenging for the treatment. Surgical resection is believed to be the optimal therapy; however, postoperative dysfunction of the lower cranial nerves (CNs), tumor residual, cerebrospinal fluid (CSF) leakage, and subcutaneous hydrops are common. The current study's objectives were to describe the optimal surgical strategies for the total removal of dumbbell-shaped JFS, the functional preservation of lower CNs, and the prevention of postoperative CSF leakage. METHODS 26 consecutive patients with dumbbell-shaped JFS were surgically treated between January 2014 and June 2019. All patients were operated on via two-piece lateral suboccipital approach, vascularized muscle flap was used for the repair of the dural defect after an operation. The clinical information and radiological data of these patients were retrospectively reviewed, and the optimal surgical strategies were further evaluated and discussed. RESULTS The tumor was completely removed in all 26 patients, one patient developed new CN Ⅶ paralysis, and 2 developed new CN IX and Ⅹ paralysis after an operation, all patients were significantly relieved during follow up. None of them developed subcutaneous hydrops and postoperative CSF leakage. No tumor recurrence was observed during a mean follow up of 38.8 (16-69) months. CONCLUSIONS Dumbbell-shaped JFS could be safely and completely removed via the two-piece lateral suboccipital approach. Postoperative CSF leakage could be effectively prevented by careful repair of the dural defect in the jugular foramen (JF) and filling the mastoid cavity with a vascularized muscular flap.
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Affiliation(s)
- Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Jie Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China.
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6
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Wang X, Yuan J, Liu D, Xie Y, Wu M, Xiao Q, Qin C, Su J, Zeng Y, Liu Q. Efficacy of the Suboccipital Paracondylar-Lateral Cervical Approach: The Series of 64 Jugular Foramen Tumors Along With Follow-Up Data. Front Oncol 2021; 11:660487. [PMID: 34722234 PMCID: PMC8552042 DOI: 10.3389/fonc.2021.660487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Complete resection of jugular foramen tumors with minimal cranial nerve complications remains challenging even for skilled neurosurgeons. Here, we introduce a modified paracondylar approach, named the suboccipital paracondylar-lateral cervical (SPCLC) approach for this purpose. We also share the follow-up data of our series and discuss the advantages and limitations of this modified paracondylar approach. Methods We included 64 patients with jugular foramen tumors who underwent surgery by the same senior neurosurgeon between November 2011 and August 2020. All patients were treated with the SPCLC approach, which aimed for gross total tumor removal in a single-stage operation. The clinical characteristics, including preoperative and postoperative neurological status, the extent of surgical resection, and follow-up data were retrospectively acquired and evaluated. Results There were 48 schwannomas, nine meningiomas, three paragangliomas, one hemangiopericytoma, one chordoma, one endolymphatic sac tumor, and one Langerhans’ cell histiocytosis. The median age of our patients was 43 years (range: 21–77 years). Dysphagia, hoarseness, and tongue deviation were observed in 36, 26, and 28 patients, respectively. Thirty-two patients had hearing function impairments, including hearing loss or tinnitus. Gross total resection was achieved in 59 patients (59/64, 92.2%). Gamma Knife treatment was used to manage residual tumors in five patients. Postoperatively, new-onset or aggravative dysphagia and hoarseness occurred in 26 and 18 cases, respectively. Nine patients developed new-onset facial palsy, and one patient developed new-onset hearing loss. There were no cases of intracranial hematoma, re-operation, tracheostomy, or death. At the latest follow-up, hearing loss and tinnitus had improved in 20 cases (20/32, 62.5%), dysphagia alleviated in 20 cases (20/36, 55.6%), and hoarseness improved in 14 cases (14/26, 53.8%). Over a mean follow-up period of 27.8 ± 19.5 months (range: 3–68 months), tumor recurrence was observed in one patient. Conclusion The SPCLC approach, modified from the paracondylar approach, and was less invasive, safe, and efficient for certain jugular foramen tumors. Taking advantage of the anatomic understanding, clear operational vision, and appropriate surgical skills, it is possible to achieve gross total tumor removal and the preservation of neurological function.
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Affiliation(s)
- Xiangyu Wang
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Jian Yuan
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Dingyang Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Yuanyang Xie
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Ming Wu
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Qun Xiao
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Chaoying Qin
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Jun Su
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Yu Zeng
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Qing Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
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Aftahy AK, Groll M, Barz M, Bernhardt D, Combs SE, Meyer B, Negwer C, Gempt J. Surgical Management of Jugular Foramen Schwannomas. Cancers (Basel) 2021; 13:cancers13164218. [PMID: 34439372 PMCID: PMC8393280 DOI: 10.3390/cancers13164218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Treatments of jugular foramen schwannomas may be challenging due to critical anatomical relations and the involvement of different aspects of the skull base. Advances in microsurgery have led to improved outcomes over recent decades, whereas in contrast, some advocate stereotactic radiotherapy as an effective therapy, controlling the tumor volume with few complications. In this manuscript, we present the outcomes and adverse events in a contemporary cohort and discuss surgical advantages and disadvantages of different performed classic skull base approaches. Abstract Background: Resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve (CN) injury remains difficult. Reoperations in this vital region are associated with severe CN deficits. Methods: We performed a retrospective analysis at a tertiary neurosurgical center of patients who underwent surgery for JFSs between June 2007 and May 2020. We included nine patients (median age 60 years, 77.8% female, 22.2% male). Preoperative symptoms included hearing loss (66.6%), headache (44.4%), hoarseness (33.3%), dysphagia (44.4%), hypoglossal nerve palsy (22.2%), facial nerve palsy (33.3%), extinguished gag reflex (22.2%), and cerebellar dysfunction (44.4%). We observed Type A, B, C, and D tumors in 3, 1, 1, and 4 patients, respectively. A total of 77.8% (7/9) underwent a retrosigmoid approach, and 33.3% (3/9) underwent an extreme lateral infrajugular transcondylar (ELITE) approach. Gross total resection (GTR) was achieved in all cases. The rate of shunt-dependent hydrocephalus was 22.2% (2/9). No further complications requiring surgical intervention occurred during follow-up. The median follow-up time was 16.5 months (range 3–84 months). Conclusions: Considering the satisfying outcome, the GTR of JFSs is feasible in performing well-known skull base approaches. Additional invasive and complicated approaches were not needed. Radiosurgery may be an effective alternative for selected patients.
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Affiliation(s)
- Amir Kaywan Aftahy
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (M.G.); (M.B.); (B.M.); (C.N.); (J.G.)
- Correspondence: ; Tel.: +49-89-4140-2151; Fax: +49-89-4140-4889
| | - Maximilian Groll
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (M.G.); (M.B.); (B.M.); (C.N.); (J.G.)
| | - Melanie Barz
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (M.G.); (M.B.); (B.M.); (C.N.); (J.G.)
| | - Denise Bernhardt
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (D.B.); (S.E.C.)
| | - Stephanie E. Combs
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (D.B.); (S.E.C.)
- Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße Ingolstädter Landstraße 1, 85764 Oberschleißheim, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Sites Munich, 80333 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (M.G.); (M.B.); (B.M.); (C.N.); (J.G.)
| | - Chiara Negwer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (M.G.); (M.B.); (B.M.); (C.N.); (J.G.)
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (M.G.); (M.B.); (B.M.); (C.N.); (J.G.)
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Constanzo F, Coelho Neto M, Nogueira GF, Ramina R. Microsurgical Anatomy of the Jugular Foramen Applied to Surgery of Glomus Jugulare via Craniocervical Approach. Front Surg 2020; 7:27. [PMID: 32500078 PMCID: PMC7243180 DOI: 10.3389/fsurg.2020.00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 11/13/2022] Open
Abstract
The jugular foramen remains one of the most complex regions of the human body. Approaching lesions in this area requires extensive anatomical knowledge and experience, due to the many critical neurovascular structures passing through or around the jugular foramen. Here, we present a concise review of the microsurgical anatomy of the jugular foramen in relation to the craniocervical approach.
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Affiliation(s)
- Felipe Constanzo
- Department of Neurological Surgery, Clinica Bio Bio, Concepcion, Chile
| | | | | | - Ricardo Ramina
- Neurosurgery Department, Neurological Institute of Curitiba, Curitiba, Brazil
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9
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Bond JD, Zhang M. Compartmental Subdivisions of the Jugular Foramen: A Review of the Current Models. World Neurosurg 2020; 136:49-57. [DOI: 10.1016/j.wneu.2019.12.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022]
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10
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Mooney MA, Almefty KK. Endoscope-Assisted, Transmastoid, High Cervical Approach for Resection of a Jugular Foramen Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E45-E46. [PMID: 31214698 DOI: 10.1093/ons/opz149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Chandler Regional Medical Center, Chandler, Arizona
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Chandler Regional Medical Center, Chandler, Arizona
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Ma SC, Liu S, Agazzi S, Jia W. The Jugular Process: A Key Anatomical Landmark for Approaches to the Jugular Foramen. World Neurosurg 2019; 135:e686-e694. [PMID: 31884127 DOI: 10.1016/j.wneu.2019.12.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Shun-Chang Ma
- Department of Neurotomy, Beijing Neurosurgical Institute, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shih Liu
- Department of Neurosurgery, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Siviero Agazzi
- Department of Neurosurgery, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Wang Jia
- Department of Neurotomy, Beijing Neurosurgical Institute, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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12
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Basma J, Michael LM, Sorenson JM, Robertson JH. Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study. J Neurol Surg B Skull Base 2019; 80:518-526. [PMID: 31534895 DOI: 10.1055/s-0038-1676512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Methods Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Results Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. Conclusion The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Jeffrey M Sorenson
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Jon H Robertson
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
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13
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Wang X, Long W, Liu D, Yuan J, Xiao Q, Liu Q. Optimal surgical approaches and treatment outcomes in patients with jugular foramen schwannomas: a single institution series of 31 cases and a literature review. Neurosurg Rev 2019; 43:1339-1350. [PMID: 31473876 DOI: 10.1007/s10143-019-01165-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Xiangyu Wang
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Wenyong Long
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Dingyang Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Jian Yuan
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Qun Xiao
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Qing Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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14
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Ma SC, Liu S, Agazzi S, Jia W. Rectus Capitis Lateralis Muscle: A Cadaveric Study of a Key Surgical Landmark in the Posterior and Lateral Approaches to the Jugular Foramen. World Neurosurg 2019; 128:e859-e864. [DOI: 10.1016/j.wneu.2019.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
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15
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Matsushima K, Kohno M, Nakajima N, Izawa H, Ichimasu N, Tanaka Y, Sora S. Retrosigmoid Intradural Suprajugular Approach to Jugular Foramen Tumors with Intraforaminal Extension: Surgical Series of 19 Cases. World Neurosurg 2019; 125:e984-e991. [DOI: 10.1016/j.wneu.2019.01.223] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022]
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16
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Matsushima K, Kohno M. Transjugular transsigmoid approach for triple dumbbell-shaped jugular foramen schwannomas. Acta Neurochir (Wien) 2019; 161:739-743. [PMID: 30830271 DOI: 10.1007/s00701-019-03860-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Jugular foramen tumors, particularly those that are triple dumbbell-shaped with intracranial, intraforaminal, and extracranial extensions, are difficult to access surgically. However, advances in neuroimaging, neuromonitoring, and skull base surgery have enabled their safe resection with lower rates of morbidity and mortality. METHOD We share our experience with the surgical technique for the management of triple dumbbell-shaped jugular foramen schwannomas. CONCLUSION The infralabyrinthine transjugular transsigmoid approach with high cervical exposure under continuous vagus nerve monitoring enables gross total resection of triple dumbbell-shaped jugular foramen schwannomas, aiming at surgical cure of these benign tumors for appropriately selected patients.
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Affiliation(s)
- Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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17
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Komune N, Matsuo S, Miki K, Matsushima K, Akagi Y, Kurogi R, Iihara K, Matsushima T, Inoue T, Nakagawa T. Microsurgical Anatomy of the Jugular Process as an Anatomical Landmark to Access the Jugular Foramen: A Cadaveric and Radiological Study. Oper Neurosurg (Hagerstown) 2018; 16:486-495. [DOI: 10.1093/ons/opy198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/01/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
- Noritaka Komune
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Matsuo
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Koichi Miki
- Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka University, Fukuoka, Japan
| | - Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yojiro Akagi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryota Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Tooru Inoue
- Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka University, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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18
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Manjila S, Bazil T, Kay M, Udayasankar UK, Semaan M. Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications. Neurosurg Focus 2018; 45:E5. [DOI: 10.3171/2018.5.focus18106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVEThere is no definitive or consensus classification system for the jugular bulb position that can be uniformly communicated between a radiologist, neurootologist, and neurosurgeon. A high-riding jugular bulb (HRJB) has been variably defined as a jugular bulb that rises to or above the level of the basal turn of the cochlea, within 2 mm of the internal auditory canal (IAC), or to the level of the superior tympanic annulus. Overall, there is a seeming lack of consensus, especially when MRI and/or CT are used for jugular bulb evaluation without a dedicated imaging study of the venous anatomy such as digital subtraction angiography or CT or MR venography.METHODSA PubMed analysis of “jugular bulb” comprised of 1264 relevant articles were selected and analyzed specifically for an HRJB. A novel classification system based on preliminary skull base imaging using CT is proposed by the authors for conveying the anatomical location of the jugular bulb. This new classification includes the following types: type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (SCC), subclassified as type 2a (without dehiscence into the middle ear) or type 2b (with dehiscence into the middle ear); type 3, between the inferior margin of the posterior SCC and the inferior margin of the IAC, subclassified as type 3a (without dehiscence into the middle ear) and type 3b (with dehiscence into the middle ear); type 4, above the inferior margin of the IAC, subclassified as type 4a (without dehiscence into the IAC) and type 4b (with dehiscence into the IAC); and type 5, combination of dehiscences. Appropriate CT and MR images of the skull base were selected to validate the criteria and further demonstrated using 3D reconstruction of DICOM files. The microsurgical significance of the proposed classification is evaluated with reference to specific skull base/posterior fossa pathologies.RESULTSThe authors validated the role of a novel classification of jugular bulb location that can help effective communication between providers treating skull base lesions. Effective utilization of the above grading system can help plan surgical procedures and anticipate complications.CONCLUSIONSThe authors have proposed a novel anatomical/radiological classification system for jugular bulb location with respect to surgical implications. This classification can help surgeons in complication avoidance and management when addressing HRJBs.
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Affiliation(s)
- Sunil Manjila
- 1Department of Neurosurgery, McLaren Bay Region Medical Center, Bay City, Michigan
| | - Timothy Bazil
- 1Department of Neurosurgery, McLaren Bay Region Medical Center, Bay City, Michigan
| | - Matthew Kay
- 2Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and
| | - Unni K. Udayasankar
- 2Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and
| | - Maroun Semaan
- 3Department of ENT, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Quantification of Surgical Route Parameters for Exposure of the Jugular Foramen Via a Trans-Mastoidal Approach Exposing Jugular Foramen in Three-Dimensional Visualization Model. J Craniofac Surg 2018; 29:787-791. [PMID: 29381617 DOI: 10.1097/scs.0000000000004234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Surgical operation within the region of the jugular foramen presents a great challenge. The authors characterized the quantitative impact of surgical window parameters on the exposure of the jugular foramen via a trans-mastoidal approach. METHODS Computed tomography and magnetic resonance imaging data were used to establish a 3-dimensional model of the jugular foramen region. The mastoidale, posterior edge of the mastoid, and the superior edge of the bony external acoustic meatus were selected as points a, b, and c. The anterior edge of the tuberculum jugulare was selected as point d. The midpoints of line segments ab, ac, and bc were selected as points e, f, and g. Triangle abc was divided into triangles aef, beg, cfg, and efg. Surgical corridors of the triangular pyramid were outlined by connecting the above triangles to point d. Anatomic exposure was evaluated by measuring the area and volume of various structures within each route. Statistical comparisons were performed via analysis of variance. RESULTS The model allowed for adequate visualization of all structures. The areas of triangles beg and efg were greater than those of triangles aef and cfg (P < 0.05). The volumes of triangular pyramids d-beg and d-cfg were greater than those of triangular pyramids d-aef and d-efg (P = 0.000). Statistically significant differences were also observed for volumes of osseous, venous, and cranial nerve structures in all divided routes (P = 0.000). CONCLUSION Our results indicate that 3-dimensional modeling may aid in the quantification of surgical exposure and that division of the craniotomy window may allow for more precise operation.
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20
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Cohen MA, Evins AI, Lapadula G, Arko L, Stieg PE, Bernardo A. The rectus capitis lateralis and the condylar triangle: important landmarks in posterior and lateral approaches to the jugular foramen. J Neurosurg 2017; 127:1398-1406. [DOI: 10.3171/2016.9.jns16723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe rectus capitis lateralis (RCL) is a small posterior cervical muscle that originates from the transverse process of C-1 and inserts onto the jugular process of the occipital bone. The authors describe the RCL and its anatomical relationships, and discuss its utility as a surgical landmark for safe exposure of the jugular foramen in extended or combined skull base approaches. In addition, the condylar triangle is defined as a landmark for localizing the vertebral artery (VA) and occipital condyle.METHODSFour cadaveric heads (8 sides) were used to perform far-lateral, extended far-lateral, combined transmastoid infralabyrinthine transcervical, and combined far-lateral transmastoid infralabyrinthine transcervical approaches to the jugular foramen. On each side, the RCL was dissected, and its musculoskeletal, vascular, and neural relationships were examined.RESULTSThe RCL lies directly posterior to the internal jugular vein—only separated by the carotid sheath and in some cases cranial nerve (CN) XI. The occipital artery travels between the RCL and the posterior belly of the digastric muscle, and the VA passes medially to the RCL as it exits the C-1 foramen transversarium and courses posteriorly toward its dural entrance. CNs IX–XI exit the jugular foramen directly anterior to the RCL. To provide a landmark for identification of the occipital condyle and the extradural VA without exposure of the suboccipital triangle, the authors propose and define a condylar triangle that is formed by the RCL anteriorly, the superior oblique posteriorly, and the occipital bone superiorly.CONCLUSIONSThe RCL is an important surgical landmark that allows for early identification of the critical neurovascular structures when approaching the jugular foramen, especially in the presence of anatomically displacing tumors. The condylar triangle is a novel and useful landmark for identifying the terminal segment of the hypoglossal canal as well as the superior aspect of the VA at its exit from the C-1 foramen transversarium, without performing a far-lateral exposure.
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Affiliation(s)
- Michael A. Cohen
- 1Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
- 2Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Alexander I. Evins
- 1Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Gennaro Lapadula
- 1Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
- 3Department of Neurology and Psychiatry, Neurosurgery, “Sapienza” University of Rome, Italy; and
| | - Leopold Arko
- 1Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
- 4Department of Neurological Surgery, Temple University Medical School, Philadelphia, Pennsylvania
| | - Philip E. Stieg
- 1Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Antonio Bernardo
- 1Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
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22
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Meybodi AT, Lawton MT, Mokhtari P, Kola O, El-Sayed IH, Benet A. Exposure of the External Carotid Artery Through the Posterior Triangle of the Neck: A Novel Approach to Facilitate Bypass Procedures to the Posterior Cerebral Circulation. Oper Neurosurg (Hagerstown) 2017; 13:374-381. [DOI: 10.1093/ons/opw024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 07/15/2016] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: The external carotid artery (ECA) is the main high-flow donor for extracranial–intracranial revascularization procedures. However, anatomic restraints limit the availability of ECA in posterior exposures of the craniocervical junction aimed for bypass to distal vertebral artery segments.
OBJECTIVE: To examine the feasibility and safety of exposure of the ECA through the posterior triangle of the neck.
METHODS: A preliminary feasibility study on the posterior neck exposure of the ECA was performed in 1 cadaveric head (2 sides) followed by a morphometric study on 9 cadaveric heads (18 sides). Through an extension of the muscular stage of the far-lateral approach, the fascial plane between the posterior belly of the digastric muscle and the capsule of the parotid gland was dissected inferior to the C1. Topographic anatomy of the exposed distal segment of the ECA was defined in detail, including bony landmarks and the facial nerve.
RESULTS: ECA was found successfully using the proposed technique in all specimens. In 90% of the specimens, ECA was exposed without transgression of the capsule of the parotid gland. The facial nerve was not encountered during the surgical exposures.
CONCLUSION: ECA can be safely and effectively exposed through the posterior triangle of the neck using the proposed approach. This method can facilitate extracranial–intracranial bypass procedures to V3/V4 vertebral artery. Advantages of this novel approach are shortening the graft length and surgical timing, less invasiveness, and optimizing surgical trajectories for completion of both donor and recipient bypass anastomosis.
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Affiliation(s)
- Ali Tayebi Meybodi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Skull Base and Cerebrovascular Laboratory, Uni-versity of California, San Francisco, San Francisco, California
| | - Michael T. Lawton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Skull Base and Cerebrovascular Laboratory, Uni-versity of California, San Francisco, San Francisco, California
| | - Pooneh Mokhtari
- Skull Base and Cerebrovascular Laboratory, Uni-versity of California, San Francisco, San Francisco, California
| | - Olivia Kola
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Skull Base and Cerebrovascular Laboratory, Uni-versity of California, San Francisco, San Francisco, California
| | - Ivan H. El-Sayed
- Skull Base and Cerebrovascular Laboratory, Uni-versity of California, San Francisco, San Francisco, California
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Arnau Benet
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Skull Base and Cerebrovascular Laboratory, Uni-versity of California, San Francisco, San Francisco, California
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, San Francisco, California
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23
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Zhang X, Tabani H, El-Sayed I, Meybodi AT, Griswold D, Mummaneni P, Benet A. Combined Endoscopic Transoral and Endonasal Approach to the Jugular Foramen: A Multiportal Expanded Access to the Clivus. World Neurosurg 2016; 95:62-70. [PMID: 27481601 DOI: 10.1016/j.wneu.2016.07.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The expanded endoscopic endonasal ("far medial") approach to the inferior clivus provides a unique surgical corridor to the ventral surface of the pontomedullary and cervicomedullary junctions. However, exposing neoplasms involving the jugular foramen (JF) through this approach requires extensive nasopharyngeal resection and lateral dissection beyond the boundaries of the endonasal corridor, limiting the extent of resection and restricting to use of this approach to expert surgeons. Here we describe a multiportal endoscopic transoral and endonasal approach to maximize surgical access to the JF and clivus. METHODS A multiportal endoscopic transoral and endoscopic approach to the JF and lower clivus was simulated in 8 specimens. A transoral corridor was created through a soft palate incision. The JF and parapharyngeal space were dissected through the transoral trajectory under endoscopic endonasal view. The length of the corridor of the transnasal and transoral trajectories was measured. RESULTS The JF was exposed intracranially and extracranially. The exposure extended superiorly to the sphenoid floor, inferiorly to the anterior atlanto-occipital space, and laterally to the internal acoustic meatus and parapharyngeal space. The cisternal parts of the cranial nerves VII-XII and C1 nerve bundles were accessible. Exposure of the JF contents and parapharyngeal space was possible using straight scopes, without Eustachian tube resection. The working corridor to the JF was significantly shorter through the mouth than through the nose (P < 0.0001). CONCLUSIONS This approach provides access to the JF from a ventromedial trajectory, enabling panoramic views, and outlines an expanded surgical exposure (superolateral intradural and inferolateral extracranial). It may provide optimal access for resection of dumbbell-shaped lesions of the JF.
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Affiliation(s)
- Xin Zhang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California San Francisco, San Francisco, California, USA; Department of Neurosurgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Halima Tabani
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Ivan El-Sayed
- Skull Base and Cerebrovascular Laboratory, University of California San Francisco, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ali Tayebi Meybodi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Dylan Griswold
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Praveen Mummaneni
- Skull Base and Cerebrovascular Laboratory, University of California San Francisco, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Arnau Benet
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California San Francisco, San Francisco, California, USA.
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