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Ramalho Rodrigues R, Neto DFDN, Andrade Fernandes JV, Barreto LDO, Barros Maciel do Amaral V, Karoline de Araújo Deca D, Freire de Albuquerque Figueiredo VL, Dantas de Lucena J, Bezerra da Silva I, Sales THDA, Oliveira ADSB. Morphological analysis of the jugular foramen in dry human skulls in northeastern Brazil. Anat Cell Biol 2024; 57:213-220. [PMID: 38449076 PMCID: PMC11184423 DOI: 10.5115/acb.23.218] [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: 08/27/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
The jugular foramen (JF) is located between the temporal and occipital bones. The JF is a primary pathway for venous outflow from the skull and passage of nerves. Variations are common in this region and may have clinical and surgical implications. To analyze the sexual dimorphism and JF morphology in skulls from Northeastern Brazil. 128 human skulls from the Anatomy Laboratory of the Federal University of Paraíba, 64 male and 64 female, were selected and the JFs analyzed for bone septation and the presence of a dome. Data analysis considered P<0.05 as significant. On at least one side, complete septation was observed in 26 skulls (20.3%), incomplete septation in 93 skulls (72.6%) and 61 skulls (47.6%) did not present septation. In 114 skulls (89%), 47.6% female and 41.4% male, have a unilateral presence of the dome and 71 (55.4%) have it bilaterally. Posterolateral compartment diameters and JF area had higher values on the right side in the total sample and separated by sex (P<0.05). Most morphometric variables of the anteromedial compartment were higher in male than in female (P<0.05), fact that was not observed in the posterolateral compartment (P>0.05). This study showed a higher prevalence of complete septation in males compared to females. Morphometric analysis presented a peculiar morphology of the JF in this study. These results suggests that the surgical approach to diseases that affect the JF may be peculiar to the studied population, confirming the importance of morphological analysis of the skull base.
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Affiliation(s)
| | | | | | | | | | | | | | - Jalles Dantas de Lucena
- Centro Universitário Santa Maria, Cajazeiras, Brazil
- Federal University of Ceará, Fortaleza, Brazil
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Castillo AL, Meybodi AT, Liu JK. Jugular Foramen Tumors: Surgical Strategies and Representative Cases. Brain Sci 2024; 14:182. [PMID: 38391756 PMCID: PMC10886589 DOI: 10.3390/brainsci14020182] [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: 12/10/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Jugular foramen tumors are complex lesions due to their relationship with critical neurovascular structures within the skull base. It is necessary to have a deep knowledge of the anatomy of the jugular foramen and its surroundings to understand each type of tumor growth pattern and how it is related to the surrounding neurovascular structures. This scope aims to provide a guide with the primary surgical approaches to the jugular foramen and familiarize the neurosurgeons with the anatomy of the region. (2) Methods and (3) Results: A comprehensive description of the surgical approaches to jugular foramen tumors is summarized and representative cases for each tumor type is showcased. (4) Conclusions: Each case should be carefully assessed to find the most suitable approach for the patient, allowing the surgeon to remove the tumor with minimal neurovascular damage. The combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach can be performed in a stepwise fashion for the resection of complex jugular foramen tumors.
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Affiliation(s)
- Andrea L Castillo
- Department of Neurological Surgery, New Jersey Medical School, Newark, NJ 07103, USA
- Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ 07039, USA
| | - Ali Tayebi Meybodi
- Department of Neurological Surgery, New Jersey Medical School, Newark, NJ 07103, USA
- Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ 07039, USA
| | - James K Liu
- Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ 07039, USA
- Skull Base Institute of New Jersey, Neurosurgeons of New Jersey, Livingston, NJ 07039, USA
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Park HH, Yoo J, Oh HC, Froelich S, Lee KS. The Anterolateral Approach, Revisited for Benign Jugular Foramen Tumors With Predominant Extracranial Extension: Microsurgical Anatomy and Case Series (SevEN-012). Oper Neurosurg (Hagerstown) 2023; 25:e135-e146. [PMID: 37195061 DOI: 10.1227/ons.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/19/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and lateral exposure than the extreme lateral and endoscopic endonasal approach, respectively. We describe the microsurgical anatomy of ALA with cadaveric specimens and report our clinical experience for benign JF tumors with predominant extracranial extension. METHODS A stepwise and detailed microsurgical neurovascular anatomy of ALA was explored with cadaveric specimens. Then, the clinical results of 7 consecutive patients who underwent ALA for benign JF tumors with predominant extracranial extension were analyzed. RESULTS A hockey stick skin incision is made along the superior nuchal line to the anterior edge of the sternocleidomastoid muscle (SCM). ALA involves layer-by-layer muscle dissection of SCM, splenius capitis, digastric, longissimus capitis, and superior oblique muscles. The accessory nerve runs beneath SCM and is found at the posterior edge of the digastric muscle. The internal jugular vein (IJV) is lateral to and at the level of the accessory nerve. The occipital artery passes over the longissimus capitis muscle and IJV and into the external carotid artery, which is lateral and superficial to IJV. The internal carotid artery (ICA) is more medial and deeper than external carotid artery and is in the carotid sheath with the vagus nerve and IJV. The hypoglossal and vagus nerves run along the lateral and medial side of ICA, respectively. Prehigh cervical carotid, prejugular, and retrojugular surgical corridors allow deep and extracranial access around JF. In the case series, gross and near-total resections were achieved in 6 (85.7%) patients without newly developed cranial nerve deficits. CONCLUSION ALA is a traditional and invaluable neurosurgical approach for benign JF tumors with predominant extracranial extension. The anatomic knowledge of ALA increases competency in adding anterior and lateral exposure of extracranial JF.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyeong-Cheol Oh
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Paris VII-Diderot University, Paris, France
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
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Lazarus L, Naidoo J, Rennie C. Bilateral tripartite dural septation of the jugular foramen. J ANAT SOC INDIA 2022. [DOI: 10.4103/jasi.jasi_123_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barros DP, Nascimento JJ, Ribeiro EC, Palmeira RG, Silva LM, Silva-Neto EJ. Relationship between jugular foramen dimensions and neurocranium shape. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bond JD, Xu Z, Zhang M. Fine configuration of the dural fibrous network and the extradural neural axis compartment in the jugular foramen: an epoxy sheet plastination and confocal microscopy study. J Neurosurg 2021; 135:136-146. [PMID: 32619988 DOI: 10.3171/2020.4.jns20811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The extradural neural axis compartment (EDNAC) is an adipovenous zone that is located between the meningeal (ML) and endosteal (EL) layers of the dura mater and has been minimally investigated in the jugular foramen (JF) region. In this study, the authors aimed to explore the fine architecture of the EDNAC within the JF and evaluate whether the EDNAC can be used as a component for JF compartmentalization. METHODS A total of 46 cadaveric heads (31 male, 15 female; age range 54-96 years) and 30 dry skulls were examined in this study. Twelve of 46 cadaveric heads were plastinated as a series of transverse (7 sets), coronal (3 sets), and sagittal (2 sets) slices and examined using stereomicroscopy and confocal microscopy. The dural entry points of the JF cranial nerves were recorded in 34 cadaveric skulls. The volumes of the JF, intraforaminal EDNAC, and internal jugular vein (IJV) were quantified. RESULTS Based on constant osseous landmarks, the JF was subdivided into preforaminal, intraforaminal, and subforaminal segments. The ML-derived fascial sheath along the anteromedial wall of the IJV demarcated the "venous portion" and the "EDNAC portion" of the bipartite JF. The EDNAC did not surround the intraforaminal IJV and comprised an ML-derived dural fibrous network and an adipose matrix. A fibrovenous curtain subdivided the intraforaminal EDNAC into a small anterior column containing cranial nerve (CN) IX and the anterior condylar venous plexus and a large posterior adipose column containing CNs X and XI. In the intraforaminal segment, the IJV occupied a slightly larger space in the foramen (57%; p < 0.01), whereas in the subforaminal segment it occupied a space of similar size to that of the EDNAC. CONCLUSIONS Excluding the IJV, the neurovascular structures in the JF traverse the dural fibrous network that is dominant in the foraminal EDNAC. The results of this study will contribute to anatomical knowledge of the obscure yet crucially important JF region, increase understanding of foraminal tumor growth and spread patterns, and facilitate the planning and execution of surgical interventions.
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Affiliation(s)
- Jacob D Bond
- 1Department of Anatomy and
- 2Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; and
| | | | - Ming Zhang
- 1Department of Anatomy and
- 3Department of Anatomy, Anhui Medical University, Hefei, China
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Bernard F, Zemmoura I, Cottier JP, Fournier HD, Terrier LM, Velut S. The interperiosteodural concept applied to the jugular foramen and its compartmentalization. J Neurosurg 2018; 129:770-778. [PMID: 28885117 DOI: 10.3171/2017.1.jns161890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe dura mater is made of 2 layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which directly covers the brain and spinal cord. These 2 dural layers join together in most parts of the skull base and cranial convexity, and separate into the orbital and perisellar compartments or into the spinal epidural space to form the extradural neural axis compartment (EDNAC). The EDNAC contains fat and/or venous blood. The aim of this dissection study was to anatomically verify the concept of the EDNAC by focusing on the dural layers surrounding the jugular foramen area.METHODSThe authors injected 10 cadaveric heads (20 jugular foramina) with colored latex and fixed them in formalin. The brainstem and cerebellum of 7 specimens were cautiously removed to allow a superior approach to the jugular foramen. Special attention was paid to the meningeal architecture of the jugular foramen, the petrosal inferior sinus and its venous confluence with the sigmoid sinus, and the glossopharyngeal, vagus, and accessory nerves. The 3 remaining heads were bleached with a 20% hydrogen peroxide solution. This procedure produced softening of the bone without modifying the fixed soft tissues, thus permitting coronal and axial dissections.RESULTSThe EDNAC of the jugular foramen was limited by the endosteal and meningeal layers and contained venous blood. These 2 dural layers joined together at the level of the petrous and occipital bones and separated at the inferior petrosal sinus and the sigmoid sinus, and around the lower cranial nerves, to form the EDNAC. Study of the dural sheaths allowed the authors to describe an original compartmentalization of the jugular foramen in 3 parts: 2 neural compartments—glossopharyngeal and vagal—and the interperiosteodural compartment.CONCLUSIONSIn this dissection study, the existence of the EDNAC concept in the jugular foramen was demonstrated, leading to the proposal of a novel 3-part compartmentalization, challenging the classical 2-part compartmentalization, of the jugular foramen.
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Affiliation(s)
| | - Ilyess Zemmoura
- 2Université François–Rabelais de Tours, Inserm, Imagerie et Cerveau, UMR U930, Tours
- Departments of 4Neurosurgery and
| | - Jean Philippe Cottier
- 2Université François–Rabelais de Tours, Inserm, Imagerie et Cerveau, UMR U930, Tours
- 5Neuroradiology, CHRU de Tours; and
| | | | - Louis-Marie Terrier
- 2Université François–Rabelais de Tours, Inserm, Imagerie et Cerveau, UMR U930, Tours
- Departments of 4Neurosurgery and
| | - Stéphane Velut
- 2Université François–Rabelais de Tours, Inserm, Imagerie et Cerveau, UMR U930, Tours
- Departments of 4Neurosurgery and
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Edwards B, Wang JM, Iwanaga J, Loukas M, Tubbs RS. Cranial Nerve Foramina: Part II - A Review of the Anatomy and Pathology of Cranial Nerve Foramina of the Posterior Cranial Fossa. Cureus 2018; 10:e2500. [PMID: 29928560 PMCID: PMC6005399 DOI: 10.7759/cureus.2500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/12/2018] [Indexed: 11/26/2022] Open
Abstract
Cranial nerve foramina are integral exits from the confines of the skull. Despite their significance in cranial nerve pathologies, there has been no comprehensive anatomical review of these structures. Owing to the extensive nature of this topic we have divided our review into two parts; Part II, presented here, focuses on the foramina of the posterior cranial fossa and discusses each foramen's shape, orientation, size, surrounding structures, and structures that pass through it. Furthermore, by comparing foramen sizes against the cross-sectional areas of their contents, we determine the amount of free space available within each. We also review lesions that can obstruct each foramen and discuss the clinical consequences.
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Affiliation(s)
- Bryan Edwards
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George, GRD
| | - Joy Mh Wang
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George, GRD
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George, GRD
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Griessenauer CJ, McGrew B, Matusz P, De Caro R, Loukas M, Tubbs RS. Surgical Approaches to the Jugular Foramen: A Comprehensive Review. J Neurol Surg B Skull Base 2016; 77:260-4. [PMID: 27175322 DOI: 10.1055/s-0035-1567863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022] Open
Abstract
Introduction Multiple surgical approaches and combinations thereof have been described to gain access to the jugular foramen. In an area laden with important neurovascular structures, care must be taken in choosing the best surgical approach for treatment of rare pathologies involving this region. Methods This manuscript provides a comprehensive review of the relevant anatomy along with an overview of the various approaches to the jugular foramen. In an attempt to simplify the various concepts, we propose a basic distinction into anterolateral and posterolateral approaches based on the main trajectory targeting the jugular foramen. Conclusion The anatomy surrounding the jugular foramen is exceedingly complex and requires in-depth understanding of skull base and head and neck relationships.
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Affiliation(s)
- Christoph J Griessenauer
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, United States
| | - Benjamin McGrew
- Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, AL, United States
| | - Petru Matusz
- Department of Anatomy, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies
| | - R Shane Tubbs
- Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, United States
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Tubbs RS, Griessenauer CJ, Bilal M, Raborn J, Loukas M, Cohen-Gadol AA. Dural Septation on the Inner Surface of the Jugular Foramen: An Anatomical Study. J Neurol Surg B Skull Base 2015. [PMID: 26225304 DOI: 10.1055/s-0034-1543973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introduction Preserving cranial nerve (CN) function during tumor removal at the jugular foramen is challenging. No anatomical study has better defined the relevant dural septations on the inner surface of the jugular foramen. This study was undertaken to elucidate this anatomy. Methods Fourteen cadaveric heads (28 sides) were dissected, and relationships of the meningeal coverings of the jugular foramen and adjacent CNs documented. A classification scheme was created to better describe the dural septations of the inner surface of the jugular foramen. Results Four types of dural septations were noted. Type I: 10 sides (36%) where a dural septation was seen between CNs IX anteriorly and X and XI posteriorly. Of these, the septum was ossified in 20%. Type II (32%) was defined as a jugular foramen with no dural septation. Type III (7%) was defined as septation between CNs IX and X anteriorly and XI posteriorly. Type IV (7 sides, 25%) or the chaotic form was defined as multiple septations within the jugular foramen that housed and divided CN rootlets. Conclusions The dural septations defined here can be used in future studies to help correlate operative strategy to meningeal morphology within the jugular foramen.
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Affiliation(s)
- R Shane Tubbs
- Department of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, United States ; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | | | - Muhammad Bilal
- Section of Neurosurgery, University of Alabama, Birmingham, Alabama, United States
| | - Joel Raborn
- Department of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, United States
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States ; Indiana University Simon Cancer Center, Indianapolis, Indiana, United States
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Makiese O, Chibbaro S, Marsella M, Tran Ba Huy P, George B. Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases. Neurosurg Rev 2011; 35:185-94; discussion 194. [PMID: 21947488 DOI: 10.1007/s10143-011-0346-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/24/2011] [Accepted: 05/24/2011] [Indexed: 11/24/2022]
Abstract
Jugular foramen paragangliomas are rare skull base tumours posing multiple complex diagnostic and management problems. We did a study to evaluate surgical technique, outcome and complications in 75 cases of tumours treated by multidisciplinary approach (i.e. combined neurosurgery, neuroradiology, ear, nose and throat surgery and intensive care unit team). Retrospective study on 75 consecutive patients with jugular foramen paragangliomas treated surgically from 1989 to 2005. Preoperative balloon occlusion test was performed in all patients as well as embolization (100%). A combined limited infratemporal and juxtacondylar approach was used in all patients. Gross total resection was achieved in 59 patients (78.7%). The most common complication was represented by lower cranial nerve deficits in five patients (6.6%), which was only temporary in three. Postoperative facial nerve weakness occurred in five cases (6.6%) and resolved in three of them. The remaining two patients underwent facial nerve reconstruction by hypoglossal/facial nerve anastomosis. Four patients (5.3%) had a postoperative cerebrospinal fluid leak, which was successfully treated by lumbar drainage. Two patients (2.7%) died because of complications related to surgical injury of lower cranial nerves: one patient developed aspiration pneumonia and septicemia and the second one developed a large cervico-bulbar hematoma that led to severe respiratory distress and ultimately global cerebral hypoxia. Paragangliomas are rare and complex skull base lesions that may be managed with low morbidity and mortality if a multidisciplinary approach is considered. Facial and lower cranial nerve postoperative deficits can be limited.
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Affiliation(s)
- Orphée Makiese
- Department of Neurosurgery, Lariboisiere Hospital Paris, Paris, France.
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[Approach to the jugular foramen and related structures - an analysis of the surgical technique based on cadaver simulation]. Neurol Neurochir Pol 2011; 45:260-74. [PMID: 21866483 DOI: 10.1016/s0028-3843(14)60079-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study presents consecutive stages of the approach to the jugular foramen and related structures. Eleven simulations of the approach were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schematic diagrams. The starting point for the discussed approach is removal of the mastoid and petrosal parts of the temporal bone, as well as the jugular process and the jugular tuberculum. It allows penetration of the jugular foramen from the back. Widening of the approach enables penetration of the jugular foramen from above and the front. Approach to the jugular foramen is a reproducible technique, which provides surgical penetration of this foramen and related structures. This approach is particularly useful in the surgical treatment of tumours expanding in the petrous pyramid, surroundings of the petrosal part of the internal carotid artery, cerebellopontine angle, subtemporal fossa and nervous-vascular bundle of the neck.
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Abstract
The anatomy of the jugular foramen is complex. It contains the lower cranial nerves and major vascular structures. Tumors that develop within it, or extend into it, provide significant diagnostic and surgical challenges. In this article, we describe the anatomy of the jugular foramen and outline an imaging protocol that can differentiate between lesions, thereby aiding diagnosis and facilitating management.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Clinic, Frankfurt am Main, Germany
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Morphology and compartmentation of the jugular foramen in adult Indian skulls. Surg Radiol Anat 2009; 32:447-53. [PMID: 19907915 DOI: 10.1007/s00276-009-0591-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Knowledge of the complex anatomy of the jugular foramen is vital for a favorable surgical outcome in technically challenging operations of this region. Various reports about the compartmentation of this foramen and the contents passing through them have come up with conflicting observations. METHOD As many as 116 dry, adult skulls were utilized to study the morphology and the compartmentation of the jugular foramen. RESULTS The study demonstrates and describes the precise location and frequency of occurrence of processes bridging the foramen and clarifies the existing ambiguity and confusion regarding the compartmentation and the contents passing through. A comprehensive classification for the bridging pattern and compartmentation of the jugular foramen is suggested. CONCLUSION This information will be of help to the clinicians for understanding clinical presentations and progression of the lesions of the jugular foramen region and planning for the operations.
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Moon WJ, Roh HG, Chung EC. Detailed MR imaging anatomy of the cisternal segments of the glossopharyngeal, vagus, and spinal accessory nerves in the posterior fossa: the use of 3D balanced fast-field echo MR imaging. AJNR Am J Neuroradiol 2009; 30:1116-20. [PMID: 19321628 DOI: 10.3174/ajnr.a1525] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The cisternal segments of the lower cranial nerves (CNs) adjacent to the jugular foramen (JF) are difficult to identify reliably by routine MR imaging. We performed a 3D balanced fast-field echo imaging technique (3D-bFFE) to obtain detailed anatomy of the cisternal segments of CNs IX, X, and XI. MATERIALS AND METHODS 3D-bFFE was used to image the cisternal segments of the lower CNs in 20 healthy volunteers. As an anatomic landmark, CSF recesses adjacent to the JF were divided into 3 parts: the recess for the cochlear aqueduct, the recess for CN IX, and the recess for the CN X/XI complex. MR images were evaluated to identify the cisternal segment of each cranial nerve in relation to these anatomic landmarks. RESULTS The mean angles of the recess for the cochlear aqueduct for CN IX and CN X/XI to the posterior petrous bone were 41.6 +/- 2.5 degrees , 69.7 +/- 3.1 degrees , and 76.0 +/- 3.4 degrees , respectively (P < .01). The mean length of the recess for the cochlear aqueduct for CN IX and the CN X/XI complex was 5.91 +/- 0.19, 5.08 +/- 0.11, and 4.76 +/- 0.13 cm, respectively (P < .01). 3D-bFFE adequately depicted the cisternal segments of CN IX on 38 sides (95%) and the CN X/XI complex on 39 sides (97.5%). CONCLUSIONS The cisternal segments of CN IX, CN X, and CN XI are well identified by using 3D-bFFE, especially by determining the angles of the CSF recesses adjacent to the JF.
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Affiliation(s)
- W-J Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Korea.
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Mattos JP, Ramina R, Borges W, Ghizoni E, Fernandes YB, Paschoal JR, Honorato DC, Borges G. Intradural jugular foramen tumors. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:997-1003. [PMID: 15608958 DOI: 10.1590/s0004-282x2004000600012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and 2001. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.
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Affiliation(s)
- João Paulo Mattos
- Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil.
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Tekdemir I, Tuccar E, Aslan A, Elhan A, Ersoy M, Deda H. Comprehensive microsurgical anatomy of the jugular foramen and review of terminology. J Clin Neurosci 2001; 8:351-6. [PMID: 11437579 DOI: 10.1054/jocn.2000.0865] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The microsurgical anatomy of the jugular foramen was studied in 12 formalin preserved cadavers (24 foramina) and 40 dry-skulls (80 foramina). The jugular foramen was exposed by microsurgical dissection with drilling from a superior to inferior direction. Observations regarding dural architecture of the jugular foramen and relationships between neurovascular structures passing through the foramen were noted in cadavers. Normal bony construction of the foramen and its variational anatomy were examined in dry-skull specimens. Using photographs and drawings, the anatomy of the jugular foramen is presented and related terminology is discussed in the light of a literature review.
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Affiliation(s)
- I Tekdemir
- Anatomy Department, Ankara University School of Medicine, Ankara, Turkey.
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Sen C, Hague K, Kacchara R, Jenkins A, Das S, Catalano P. Jugular foramen: microscopic anatomic features and implications for neural preservation with reference to glomus tumors involving the temporal bone. Neurosurgery 2001; 48:838-47; discussion 847-8. [PMID: 11322444 DOI: 10.1097/00006123-200104000-00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Our goals were to study the normal histological features of the jugular foramen, compare them with the histopathological features of glomus tumors involving the temporal bone, and thus provide insight into the surgical management of these tumors with respect to cranial nerve function. METHODS Ten jugular foramen blocks were obtained from five human cadavers after removal of the brain. Microscopic studies of these blocks were performed, with particular attention to fibrous or bony compartmentalization of the jugular foramen, the relationships of the caudal cranial nerves to the jugular bulb/jugular vein and internal carotid artery, and the fascicular structures of the nerves. In addition, we studied the histopathological features of 11 glomus tumors involving the temporal bone (10 patients), with respect to nerve invasion, associated fibrosis, and carotid artery adventitial invasion. RESULTS A dural septum separating the IXth cranial nerve from the fascicles of Cranial Nerves X and XI, at the intracranial opening, was noted. Only two specimens, however, had a septum (one bony and one fibrous) producing internal compartmentalization of the jugular foramen. The cranial nerves remained fasciculated within the foramen, with the vagus nerve containing multiple fascicles and the glossopharyngeal and accessory nerves containing one and two fascicles, respectively. All of these nerve fascicles lay medial to the superior jugular bulb, with the IXth cranial nerve located anteriorly and the XIth cranial nerve posteriorly. All nerve fascicles had separate connective tissue sheaths. A dense connective tissue sheath was always present between the IXth cranial nerve and the internal carotid artery, at the level of the carotid canal. The inferior petrosal sinus was present between the IXth and Xth cranial nerves, as single or multiple venous channels. The glomus tumors infiltrated between the cranial nerve fascicles and inside the perineurium. They also produced reactive fibrosis. In one patient, in whom the internal carotid artery was also excised, the tumor invaded the adventitia. CONCLUSION Within the jugular foramen, the cranial nerves lie anteromedial to the jugular bulb and maintain a multifascicular histoarchitecture (particularly the Xth cranial nerve). Glomus tumors of the temporal bone can invade the cranial nerve fascicles, and infiltration of these nerves can occur despite normal function. In these situations, total resection may not be possible without sacrifice of these nerves.
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Affiliation(s)
- C Sen
- Department of Neurosurgery, The Mount Sinai Medical Center, New York, New York, USA.
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Sen C, Hague K, Kacchara R, Jenkins A, Das S, Catalano P. Jugular Foramen: Microscopic Anatomic Features and Implications for Neural Preservation with Reference to Glomus Tumors Involving the Temporal Bone. Neurosurgery 2001. [DOI: 10.1227/00006123-200104000-00029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tekdemir I, Tuccar E, Aslan A, Elhan A, Deda H, Ciftci E, Akyar S. The jugular foramen: a comparative radioanatomic study. SURGICAL NEUROLOGY 1998; 50:557-62. [PMID: 9870816 DOI: 10.1016/s0090-3019(98)00048-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advances in microsurgical techniques made possible the removal of advanced jugular foramen (JF) lesions, which once had been accepted as unoperable. However, successful surgery requires detailed knowledge of the JF anatomy. METHODS Sixteen jugular foramina in eight formalin-preserved adult cadavers were scanned with axial and coronal high resolution computed tomography (HRCT) prior to dissection. After craniectomy and removal of brain tissue, the relationships of the neurovascular structures in the JF were determined by drilling the temporal bones from superior to inferior on planes parallel to the skull base. RESULTS No bony partition of the JF was observed. A dural band consistently divided the JF into two parts. Anterior to it was the glossopharyngeal nerve (IX) while the vagus (X) and accessory (XI) nerves were located posteriorly. There was a notch in which the IX nerve entered the JF. It was also identified on the CT scans and defined as the glossopharyngeal recess. The IX nerve made a genu within the JF in all specimens. Then, it ran inferiorly through a bony canal in three specimens (18.75%), and through an incomplete bony canal in two (12.5%), which were also defined on the CT images. The inferior petrosal sinus ran through a sulcus anteromedial to the glossopharyngeal recess. The posterior meningeal artery was found to be located between the X and XI nerves within the JF. CONCLUSIONS This study revealed a complex and highly variable pattern of the relationships of the neurovascular structures in the JF, and their HRCT images correlated well with the anatomic microdissections.
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Affiliation(s)
- I Tekdemir
- Anatomy Department of Ankara University School of Medicine, Turkey
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Van Loveren HR, Liu SS, Pensak ML, Keller JT. Anatomy of the jugular foramen: The neurosurgical perspective. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s1043-1810(96)80019-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
The microsurgical anatomy of the jugular foramen was studied in 10 fixed cadavers, each cadaver consisting of the whole head and neck. Five of the cadavers were injected with latex. The jugular foraminal region was exposed using the infratemporal fossa type A approach of Fisch and Pillsbury in five cadavers (10 sides) and the combined cervical dissection-mastoidectomy-suboccipital craniectomy approach in five cadavers (10 sides). The right foramen was larger than the left in seven cases (70%), equal in two cases (20%), and smaller in one case (10%). The dura covering the intracranial portal of the foramen had two perforations, a smaller anteromedial perforation through which passed the ninth cranial nerve (CN IX), and a larger posterolateral perforation, through which passed the 10th and 11th cranial nerves (CNs X and XI) and the distal sigmoid sinus. The perforations were separated by a fibrous septum in 16 specimens (80%). After exiting the posterior fossa, CNs IX, X, and XI all lay anteromedial to the superior jugular bulb (SJB) within the jugular foramen. The inferior petrosal sinus (IPS) entered the foramen between CNs IX and X in most cases; however, in 10% of our cases it entered the foramen between CNs X and XI, and in 10% it entered the foramen caudal to CN XI. The IPS terminated in the SJB in 90% of our cases; in 40%, the IPS termination consisted of multiple channels draining into both the SJB and internal jugular vein. This study shows that the arrangement of the neurovascular structures within the jugular foramen does not conform to the hitherto widely accepted notion of discrete compartmentalization into an anteromedial pars nervosa containing CN IX and the IPS and a posterolateral pars venosa containing the SJB, CNs X and XI, and the posterior meningeal artery.
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Affiliation(s)
- S A Ayeni
- Department of Neurosurgery, Osaka City University Medical School, Japan
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Saleh E, Naguib M, Aristegui M, Cokkeser Y, Sanna M. Lower skull base: anatomic study with surgical implications. Ann Otol Rhinol Laryngol 1995; 104:57-61. [PMID: 7832543 DOI: 10.1177/000348949510400109] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
With advances in the lateral approaches to the skull base and the increasing success of the management of jugular foramen lesions, a thorough knowledge of the anatomy of this region is needed. The purpose of the present work is to study the detailed microsurgical anatomy of the lower skull base and the jugular foramen area as seen through the lateral approaches. Forty preserved skull base specimens and 5 fresh cadavers were dissected. The shape of the jugular bulb and its relationship to nearby structures were recorded. The different venous connections of the bulb were noted. The hypoglossal canal was identified and its contents were observed. The lower cranial nerves were studied at the level of the upper neck, at their exit from the inferior skull base, and in the jugular foramen. The results of the present study showed the complex and variable anatomy of this area. The classic compartments of the jugular foramen were not always present. Cranial nerves IX through XI followed different patterns while passing through the jugular foramen, being separated from the jugular bulb by bone, thick fibrous tissue, or thin connective tissue.
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Affiliation(s)
- E Saleh
- Gruppo Otologico, Piacenza, Italy
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Conroy GC. Cranial asymmetry in Ceboid primates: The emissary foramina. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1981. [DOI: 10.1002/ajpa.1330550205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Conroy GC. Cerebral venous hemodynamics and the basicranium of Cebus. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1980; 53:37-42. [PMID: 7416247 DOI: 10.1002/ajpa.1330530107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The study of basicranial foramina has played an important role in primatological investigations. They are often the only clues for deciphering cerebral vascular evolution in fossil forms. This study illustrates the significance of considering foraminal shape when analyzing or describing basicranial anatomy in living and fossil primates. It is suggested that certain hemodynamic properties of cerebral venous drainage in Cebus represent patterns that were most likely present in ancestral catarrhines.
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Solter M, Paljan D. Variations in shape and dimensions of sigmoid groove, venous portion of jugular foramen, jugular fossa, condylar and mastoid foramina classified by age, sex and body side. ZEITSCHRIFT FUR ANATOMIE UND ENTWICKLUNGSGESCHICHTE 1973; 140:319-35. [PMID: 4749136 DOI: 10.1007/bf00525059] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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