Nonchromaffin Paraganglioma of the Jugular Foramen
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Jugular foramen
Objective: To provide the microanatomical basis for surgical treatment of lesions related to jugular forament Methods: The jugular foramen were observed and measured under the surgical microscope on 20 adult cadaveric head specimens fixed in formalin and 10 adult skull specimens.Results: The jugular foramen was divided into three compartments: the sigmoid part, the petrosal part and the neural part. The latter was located between the sigmoid and petrosal parts, and the glossopharyngeal, vagus and accessory nerves passed throuhg it. The length of jugular foramen was 13.4±1.1 mm; the width of sigmoid part was 9.1 ± 1.9 mm; height of sigmoid part was 7. 3 ± 2. 2 mm; the distance between the exocranial and endocranial of jugular forament was 12. 7 ± 1.5 mm. The jugular bulb received drainages from both intracanial and extracranial source was housed in the jugular fossa, and it had a very thin wall. There were three high jugular bulbs in 20 sides of cadaver head specimens. Conclusion: The vital nerves and vascular structures can be protected in operation if we are familiar with the microsurgical anatomy of the jugular foramen.
Jugular foramen
Sigmoid sinus
Cadaveric spasm
Jugular vein
Inferior petrosal sinus
Foramen
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Objective
To discuss the impact of trans-condyle and trans-jugular process routes in the far lateral approach upon the exposure of realated anatomic structures based on virtual reality anatomic model.
Methods
CT and MR scans were performed to fifteen adult cadaver heads, and then, image data was input into Vitrea Fx 3.0 virtual reality system to establish three-dimensional anatomy model of jugular foramen region. Anterior edge of jugular tubercle in posterior cranial fossa was selected as landmark point to outline cylinder with diameter 1 cm simulating trans-condyle and trans-jugular process routes in far lateral minimally invasive approach. Anatomic exposures and the volume were observed and measured. Statistical comparison was launched by paired t test.
Results
Anatomic structures of osseous structures, nerves and vessels in the trans-condyle and trans-jugular process routes were displayed well. Brainstem, cerebellar, vertebral artery and posterior inferior cerebellar artery did not show in route. Trans-condyle route involved partial vagus nerve and accessory nerve. Trans-jugular process route involved partial internal jugular vein and jugular bulb. Comparison did not show statistically significant differences for the volumes of two routes [(3236.20±228.01) mm3 vs (3306.00±248.23) mm3] and hypoglossal nerve involved(all P values>0.05). The volumes of osseous structures and anterior inferior cerebellar artery involved in trans-condyle route were more than those in trans-jugular process route with statistically significant differences. The volume of vein in trans-jugular process route was more than that in trans-condyle route with statistically significant difference(t=7.324, 56.526, 140.580, all P values<0.01).
Conclusions
The routes from two directions in the far lateral approach can expose hypoglossal nerve effectively, of which trans-condyle route is prone to expose anterior inferior cerebellar artery. Trans-jugular process route can bypass the lower cranial nerve but with the risk of vein injury.
Key words:
Neurosurgical procedures; Cranial fossa, posterior; Neuronavigation; Models, anatomic; Minimal invasive
Jugular foramen
Occipital condyle
Jugular vein
Hypoglossal nerve
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Objective:To investigate the microsurgical anatomy of the osseous jugular foramen (JF) and the adjacent structures. Methods:The jugular foramina and the adjacent structures of 40 adult dry akulls were examined under 3×magnification. Results:JF was divided into the petrosal and sigmoid portion. The intracranial orifice was basically triangle in 53 8% of JF. The right JF was larger than the left in 67 5% of cases from intracranial orifice and in 72 5% from extracranial orifice. The internal acoustic meatus and the external os of the vestibular aqueduct locate above JF. On the extracranial side,the styloid process and the stylomastoid foramen were lateral to JF. The jugular process of the occipital bone was posterior to JF. The tympanomastoid notch was lateral to the stylomastoid foramen. Conclusion:The right JF is larger than the left in more cases. More than half of the JF is basically triangle from intracranial orifice. The styloid process and the juguar process of the occipital bone are the landmarks to identify JF. The tympanomastoid notch is the useful landmark to locate the stylomastoid foramen.
Jugular foramen
Meatus
Mastoid process
Foramen
Occipital bone
Vestibular aqueduct
Sigmoid sinus
Eustachian tube
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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.
Jugular foramen
Foramen
Cranial nerves
Occipital bone
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Objective To investigate the microsurgical anatomy of the jugular foramen (JF) and the adjacent structures. Methods The JF and the adjacent structures were examined under 3 times of magnification in 40 dry skulls and 30 cadaveric specimens of adults. Results The right JF was larger than the left one in 65.7% of intracranial orifice and in 70. 0% of extracranial orifice. The styloid process was lateral to, and the jugular process of the occipital bone was posterior to the JF respectively. The tympanomastoid notch was lateral to the stylomastoid foramen. The cranial nerve (CN) IX, X and XI passed the petrosal portion of JF in 70.6% of cases, while only CN IX passed the petrosal portion of JF in 29.4% of cases. The inferior petrosal sinus (IPS) joined the jugular bulk (JB) between CN IX and X in 93.0% of cases. The inferior part of vertical segment of the CN Ⅶ projected tympanomastoid fissure in 80.0% of cases. Conclusion The right JF is larger than the left one in most cases. The number of the cranial nerve passing the petrosal portion of JF is related to the width of the dural septum between the glossopharyngea and vagal meati. The styloid process, the jugular process of the occipital bone and the rectus capitis lateralis are excellent landmarks to locate the JF. The tympanomastoid fissure, the tympanomastoid notch and the posterior belly of the digastric provide useful landmarks for identifying the CN Ⅶ.
Jugular foramen
Mastoid process
Inferior petrosal sinus
Occipital bone
Cadaveric spasm
Foramen
Occipital condyle
Sinus (botany)
Posterior cranial fossa
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Meningioma, which usually occurs in the intracranial fossa, occurs only extremely rarely in temporal bone. Tumors extending to the mesotympani are so similar that differentiating between meningioma and paraganglioma is very difficult. We report a case preoperatively diagnosed as glomus jugulare involving radical dissection, but determined postoperatively to be jugular foramen meningioma. Although the subject’s postoperative condition remains satisfactory, follow up must include collaboration with the neurosurgeon. It cannot be emphasized enough that jugular foramen meningioma must be diagnosed from characteristic radiological findings and differentiated from paraganglioma.
Jugular foramen
Foramen
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Jugular foramen
Sigmoid sinus
Inferior petrosal sinus
Neurovascular bundle
Glossopharyngeal nerve
Sinus (botany)
Foramen
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Objective:To study the normal anatomic features of the jugul ar foramen and the Ⅸ,Ⅹ,Ⅺ crani-al nerves, and clarify the concept of the jug ular foramen on the basis of microscopic studies. Methods:Ten adult cadavers re moved of the brain and twenty-five dry skull species were observed and measured by using microscopic skills.Particular attention to the compartmentalization of the jugular foramen and the relationships of the caudal cranial nerves to the jugular bulb were analyzed. Results: Fiber septum(16 species,80%)or bony sept um(4 species, 20%) separating partly the cranial nerve Ⅸ from the cranial nerve Ⅹ and Ⅺ was observed. Only one dry skull specimens had a septum producing ent irely internal compartment of the jugular foramen. All nerves lay anteromedially to the jugular bulb with separate connective tissue sheaths. A dense tissue was always presented between the Ⅸ cranial nerve and the internal carotid artery. Conclusions: This study suggest that the jugular foramen can be divided into neu ral part, petrosal part and sigmoid part. The nerves come together by means of d iscrete trunks in the jugular foramen with loosing contaction each other. This c onfiguration may help us to recognize and protect the cranial nerves during the operation.
Jugular foramen
Cranial nerves
Foramen
Glossopharyngeal nerve
Middle cranial fossa
Accessory nerve
Cranial cavity
Posterior cranial fossa
Base of skull
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Jugular foramen
Glomus tumor
Internal jugular vein
Glossopharyngeal nerve
Cranial nerves
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PURPOSE To define the variations of the courses of the cranial nerves and the inferior petrosal sinuses as they enter and traverse the jugular foramen. METHODS Thirty-nine cadaveric specimens containing the jugular foramen were scanned with 1-mm contiguous axial and coronal CT sections. Each specimen was dissected to evaluate the position of the cranial nerves and inferior petrosal sinus as they entered the jugular foramen. RESULTS The glossopharyngeal nerve entered the most superior, anterior, and medial aspect of the jugular foramen and descended in the anterior portion of the jugular foramen, often within a groove. The vagus and accessory nerves could not be separated by CT. They entered the jugular foramen most often anterior or anterior and inferior to the jugular spine of the temporal bone and descended in a position ranging from medial to anterior to the jugular vein. The inferior petrosal sinus most often coursed inferior to the horizontal portion of the glossopharyngeal nerve and entered the jugular system in the jugular foramen, at the exocranial opening or below the skull base. A pars nervosa and pars venosa could be identified only at the endocranial opening, where the jugular spine separated the pars nervosa containing the inferior petrosal sinus and three cranial nerves from the pars venosa containing the jugular vein. CONCLUSION Our evaluation demonstrated anatomic variation in the area of the jugular foramen.
Jugular foramen
Inferior petrosal sinus
Glossopharyngeal nerve
Cranial nerves
Sinus (botany)
Foramen
Internal jugular vein
Jugular vein
Sigmoid sinus
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