Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

Miller, Matthew; Pearl, Monica S.; Wyse, Emily; Olivi, Alessandro; Francis, Howard W.

doi:10.1055/s-0035-1566302

Cited by 4 publications

(7 citation statements)

References 21 publications

(34 reference statements)

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“…Combination of dehiscences An HRJB, if encountered in the translabyrinthine approach of acoustic schwannomas, can be exposed after extensive bone decortication and decompressed during surgery by pressure using Gelfoam and cottonoids. 23 The relationship of an HRJB in a transotic approach is critical as it can hamper the near-circumferential exposure of the IAC in the latter. 46 HRJBs can make endoscopic access to the IAC very difficult in certain cases, just like in other skull base approaches to the region.…”

Section: Typementioning

confidence: 99%

“…6,18,45 Miller et al described the usefulness of decompressing and retracting the jugular bulb to improve infralabyrinthine drainage of cholesterol granulomas. 23 They also demonstrated surgical techniques for jugular bulb decompression and retraction to expand infralabyrinthine access for the biopsy and gain access to petroclival tumors with minimal to no intracranial extension. 23…”

Section: Typementioning

confidence: 99%

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Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Manjila

Bazil

Kay

et al. 2018

Neurosurgical Focus

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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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Section: Typementioning

confidence: 99%

Section: Typementioning

confidence: 99%

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Manjila

Bazil

Kay

et al. 2018

Neurosurgical Focus

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“…Due to the sizable dimension of these extradural lesions at the time of diagnosis, a single- or multiple-stage procedure with different approaches is necessary to achieve the surgical goal while minimizing neurologic deficits. The transmastoid infralabyrinthine approach (TI-A) without rerouting of the facial nerve (FN) has been described as a feasible and safe approach for the part of these lesions located extradurally at the PA and petroclival junction (PJ) [ 12 , 13 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…Usually, to increase the infralabyrinthine extradural access to the PA and PJ, the jugular bulb (JB) is skeletonized and slightly compressed downwards [ 26 ]. However, skeletonizing of the JB carries the risk of bulb injury, which can lead to significant bleeding and air embolism and may trigger thrombosis, brain edema, or venous infarction through compression of the JB [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing the feasibility of the transmastoid infralabyrinthine approach without decompression of the jugular bulb to the extradural part of the petrous apex and petroclival junction prior to surgery

Cinibulak,

Poggenborg,

Schliwa

et al. 2024

Acta Neurochir

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Background and objective This study aims to define specific measurements on cranial high-resolution computed tomography (HRCT) images prior to surgery to prove the feasibility of the navigated transmastoid infralabyrinthine approach (TI-A) without rerouting of the facial nerve (FN) and decompression of the jugular bulb (JB) in accessing the extradural-intrapetrous part of petrous bone lesions located at the petrous apex and petroclival junction. Materials and methods Vertical and horizontal distances of the infralabyrinthine space were measured on cranial HRCT images prior to dissection. Subsequently, the area of access was measured on dissected human cadaveric specimens. Infralabyrinthine access to the extradural part of the petrous apex and petroclival junction was evaluated on dissected specimens by two independent raters. Finally, the vertical and horizontal distances were correlated with the area of access. Results Fourteen human cadaveric specimens were dissected bilaterally. In 54% of cases, the two independent raters determined appropriate access to the petrous apex and petroclival junction. A highly significant positive correlation (r = 0.99) was observed between the areas of access and the vertical distances. Vertical distances above 5.2 mm were considered to permit suitable infralabyrinthine access to the extradural area of the petrous apex and petroclival junction. Conclusions Prior to surgery, vertical infralabyrinthine distances on HRCT images above 5.2 mm provide suitable infralabyrinthine access to lesions located extradurally at the petrous apex and petroclival junction via the TI-A without rerouting of the FN and without decompression of the JB.

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“…6 We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window 6 that has been detailed in cadaveric studies. 7,8 This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves.…”

mentioning

confidence: 99%

Suprabulbar Approach to Jugular Fossa Tumors: 2-Dimensional Operative Video

Aboud²,

Al‐Mefty

2021

Operative Surg.

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Owing to their scarcity, location, and intricate neurovascular associations, jugular fossa tumors are among the most challenging pathologies encountered by the neurosurgeon.1 While paragangliomas originate within and often occlude the jugular bulb, schwannomas and meningiomas are extra-bulbar and typically do not impede venous flow.2 Schwannomas typically arise from an extradural origin, expanding the jugular foramen.3-5 Meningiomas are intradural and cause hyperostosis of the jugular tubercle.6 We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window6 that has been detailed in cadaveric studies.7,8 This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves. The carotid artery can be identified by neuronavigation and micro-Doppler ultrasonography. This approach provides a direct lateral trajectory with a short distance to the jugular fossa and cerebellopontine angle. Early exposure and central debulking of the tumor minimize manipulation of the exquisitely sensitive lower cranial nerves. The distal aspect of these tumors can be removed with endoscopic assisted techniques.9 The first patient is a 49-yr-old woman with a previously irradiated schwannoma who presented with worsening neurologic deficits—an extradural suprabulbar approach was used to resect this tumor. The second patient is a 27-yr-old woman with an enlarging meningioma and associated neurological dysfunction; this tumor was resected using the suprabulbar approach with opening of the presigmoid dura. Both patients have consented to surgery and publication of images. Image at 2:27 and 6:38 reprinted from Arnautović et al, with permission from JNSPG. Image at 2:50 and 6:45 ©Ossama Al-Mefty 1997, reused with permission.

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Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

Cited by 4 publications

References 21 publications

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Assessing the feasibility of the transmastoid infralabyrinthine approach without decompression of the jugular bulb to the extradural part of the petrous apex and petroclival junction prior to surgery

Suprabulbar Approach to Jugular Fossa Tumors: 2-Dimensional Operative Video

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