Surgical approaches to jugular foramen schwannomas: An anatomic study

Komune, Noritaka; Matsushima, Ken; Matsushima, Toshio; Komune, Shizuo; Rhoton, Albert L.

doi:10.1002/hed.24156

Cited by 38 publications

(20 citation statements)

References 58 publications

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“…Jugular foramen schwannomas are another subset of skull base lesions in which an HRJB can be a surgical risk for intraoperative hemorrhage. 17 The jugular foramen can be accessed via many approaches, including a postauricular transtemporal approach, retrosigmoid approach, far-lateral approach, and preauricular subtemporal-infratemporal approach, to name a few. There are many microsurgical modifications and endoscopeassisted options described in the neurosurgical literature.…”

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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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%

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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“…The jugular foramen can be approached laterally through the mastoid and the upper neck, posteriorly through the far-lateral approach, anterolaterally through the preauricular infratemporal approach, or anteriorly through an endoscopic endonasal approach. 5,9,10,13 When approaching the jugular foramen anteriorly, the contents of the jugular foramen are encountered prior to the RCL; thus, the relevance of the RCL as a surgical landmark is limited to the posterolateral approaches, including the farlateral and extended far-lateral, and the lateral approaches described herein, including the combined transmastoid transcervical as well as the combined far-lateral transmastoid transcervical approaches (Fig. 8).…”

Section: Discussionmentioning

confidence: 99%

“…2,6,7 For extended far-lateral approaches to the jugular foramen, the identification and reflection of the RCL, which overlays the structures exiting the jugular foramen, is the first step in safely exposing the jugular process, the surrounding neurovascular structures, and the carotid sheath. 9,13 The RCL in this context is especially important in the presence of tumors that laterally displace the closely spaced neurovascular structures exiting the jugular foramen.…”

Section: Discussionmentioning

confidence: 99%

The rectus capitis lateralis and the condylar triangle: important landmarks in posterior and lateral approaches to the jugular foramen

Cohen

Evins

Lapadula

et al. 2017

Journal of Neurosurgery

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OBJECTIVE The 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. METHODS Four 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. RESULTS The 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. CONCLUSIONS The 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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“…17 Although there is a wide variability in the involved steps, several approaches overlap and there is a lack of a standard surgical language to simplify the anatomical understanding and the rationale behind choosing the appropriate surgical approach for individual cases. 18 Our approach has been to use the lateral distal cervical postauricular approach to access pathologies involving the jugular foramen. 19,20 This approach offers a straightforward corridor to the region, and its versatility allows for multiple adaptations to specific lesions.…”

Section: Introductionmentioning

confidence: 99%

Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study

et al. 2018

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Keywords► jugular foramen ► far lateral ► infralabyrinthine approach ► styloid process ► occipital condyle ► cranial nerves ► distal cervical approach AbstractIntroduction 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 targetguided 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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Surgical approaches to jugular foramen schwannomas: An anatomic study

Abstract: An understanding of the anatomy of the jugular foramen is crucial in achieving total tumor removal while minimizing risk. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1041-E1053, 2016.

Cited by 38 publications

References 58 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

The rectus capitis lateralis and the condylar triangle: important landmarks in posterior and lateral approaches to the jugular foramen

Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study

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