scholarly journals Skull Base Osteomyelitis from Otitis Media Presenting as the Collet-Sicard Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Wong-Kein Low ◽  
Hui-Ling Lhu
Keyword(s):  
Skull Base ◽  
Otitis Media ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Jugular Foramen ◽  
Cotton Swab ◽  
Suppurative Otitis Media ◽  
Atypical Case ◽  
Skull Base Osteomyelitis ◽  
Clinical Syndromes

Skull base osteomyelitis can involve the jugular foramen and its associated cranial nerves resulting in specific clinical syndromes. The Collet-Sicard syndrome describes the clinical manifestations of palsies involving cranial nerves IX, X, XI, and XII. We present a rare atypical case of skull base osteomyelitis originating from infection of the middle ear and causing the Collet-Sicard syndrome. Caused by Pseudomonas aeruginosa and Klebsiella pneumoniae, this occurred in an elderly diabetic man subsequent to retention of a cotton swab in an ear with chronic suppurative otitis media. This case report illustrates the possibility of retained cotton swabs contributing to the development of otitis media, skull base osteomyelitis, and ultimately the Collet-Sicard syndrome in the ears of immune-compromised patients with chronically perforated eardrums.

The Asterion-to-Transverse Process of the Atlas Line as a Surgical Landmark

2021 ◽  
Author(s):  
Jaafar Basma ◽  
Dom E. Mahoney ◽  
Christos Anagnostopoulos ◽  
L. Madison Michael ◽  
Jeffrey M. Sorenson ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Three Dimensional ◽  
Transverse Process ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Sigmoid Sinus ◽  
Cervical Region ◽  
Surgical Approaches ◽  
Anatomical Location

Abstract Introduction Proposed landmarks to predict the anatomical location and trajectory of the sigmoid sinus have varying degrees of reliability. Even with neuronavigation technology, landmarks are crucial in planning and performing complex approaches to the posterolateral skull base. By combining two major dependable structures—the asterion (A) and transverse process of the atlas (TPC1)—we investigate the A-TPC1 line in relation to the sigmoid sinus and in partitioning surgical approaches to the region. Methods We dissected six cadaveric heads (12 sides) to expose the posterolateral skull base, including the mastoid and suboccipital bone, TPC1 and suboccipital triangle, distal jugular vein and internal carotid artery, and lower cranial nerves in the distal cervical region. We inspected the A-TPC1 line before and after drilling the mastoid and occipital bones and studied the relationship of the sigmoid sinus trajectory and major muscular elements related to the line. We retrospectively reviewed 31 head and neck computed tomography (CT) angiograms (62 total sides), excluding posterior fossa or cervical pathologies. Bone and vessels were reconstructed using three-dimensional segmentation software. We measured the distance between the A-TPC1 line and sigmoid sinus at different levels: posterior digastric point (DP), and maximal distances above and below the digastric notch. Results A-TPC1 length averaged 65 mm and was posterior to the sigmoid sinus in all cadaver specimens, coming closest at the level of the DP. Using the transverse-asterion line as a rostrocaudal division and skull base as a horizontal plane, we divided the major surgical approaches into four quadrants: distal cervical/extreme lateral and jugular foramen (anteroinferior), presigmoid/petrosal (anterosuperior), retrosigmoid/suboccipital (posterosuperior), and far lateral/foramen magnum regions (posteroinferior). Radiographically, the A-TPC1 line was also posterior to the sigmoid sinus in all sides and came closest to the sinus at the level of DP (mean, 7 mm posterior; range, 0–18.7 mm). The maximal distance above the DP had a mean of 10.1 mm (range, 3.6–19.5 mm) and below the DP 5.2 mm (range, 0–20.7 mm). Conclusion The A-TPC1 line is a helpful landmark reliably found posterior to the sigmoid sinus in cadaveric specimens and radiographic CT scans. It can corroborate the accuracy of neuronavigation, assist in minimizing the risk of sigmoid sinus injury, and is a useful tool in planning surgical approaches to the posterolateral skull base, both preoperatively and intraoperatively.

scholarly journals Extended Anterolateral Infralabyrinthine Transjugular Approach for Microsurgical Resection of Giant Glomus Vagale Tumor: Operative Video and Technical Nuances

2020 ◽  
Author(s):  
James K. Liu ◽  
Kevin Zhao ◽  
Soly Baredes ◽  
Robert W. Jyung
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Neck Mass ◽  
Preoperative Embolization ◽  
Rare Type ◽  
Lower Cranial Nerve ◽  
Microsurgical Resection ◽  
The Right ◽  
Lower Cranial Nerves

AbstractGlomus vagale tumor is a paraganglioma of the vagus nerve. It is a rare type of benign tumor that occupies the head and neck and skull base regions. Patients often present with lower cranial nerve dysfunctions such as difficulty swallowing, tongue weakness, and hoarseness. Surgical treatment can be complex and difficult due to its high vascularity, frequent involvement of lower cranial nerves, and surrounding critical vascular structures. In this operative video, we demonstrate an extended anterolateral infralabyrinthine transjugular approach for microsurgical resection of a giant glomus vagale tumor in a 53-year-old male who presented with an enlarging neck mass, difficulty swallowing, right tongue weakness, and hoarseness. Imaging revealed a giant glomus vagale tumor in the right parapharyngeal space extending into the jugular foramen with occlusion of the internal jugular vein. After preoperative embolization, the patient underwent a near-total resection of the tumor with a small microscopic residual at the pars nervosa. In summary, the extended anterolateral infralabyrinthine transjugular approach is a useful strategy for removal of giant glomus vagale tumors extending into the skull base. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/L0EosQK95LE.

scholarly journals Osteological studies of skull base neurovascular area in reference to infratemporal approach to skull basec

2021 ◽  
Vol 4 (3) ◽  
pp. 89-93
Author(s):  
Harsh Sharma
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Relative Size ◽  
Jugular Foramen ◽  
Surgical Approaches ◽  
Carotid Canal ◽  
Stylomastoid Foramen ◽  
Lateral Skull Base ◽  
Infratemporal Approach ◽  
Relationship Of

Surgical approaches to the lateral skull base often lead to tearing of vessels and piecemeal removal of the tumour. This study is aimed to delineate exact relationship of the various foramina at the lateral skull base. The coronal dimensions of the jugular foramina are larger as compared to sagittal with right sided dominance also noticed in the case of carotid canal. The width of “Keel” separating the carotid and jugular foramina normally varies from 0.4 to1.4 centimetres and may not always suggest the erosion of the foramen of skull base scans, unless the erosion is associated with irregularity or demineralization the thickness of this keel really depends upon relative size of the vessels and location of foramina. Area between stylomastoid foramen, carotid canal and jugular foramen is roughly wedge shaped. The angle subtended by carotid and jugular at the stylomastoid foramen is about 36.84whereas the location of stylomastoid foramen and internal carotid axis pose an angle of 83:16. The angle subtended by stylomastoid and jugular at carotid on an average 59:31. The space between these structures is measured to be 0.642centimetres which can be verified on tomograms. By using these measurements, the precise location of the upper end of the vessels could be predicted, whereas the superior stump could be clamped with minimal exposure of the skull base and identification and location of the last four cranial nerves is found out. This could avoid injuries and subsequent morbidity while carrying out surgery in this region.

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy

2002 ◽  
Vol 116 (7) ◽  
pp. 556-558 ◽  
Author(s):  
R. G. Rowlands ◽  
G. K. Lekakis ◽  
A. E. Hinton
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Jugular Foramen ◽  
Radiological Investigation ◽  
Lower Cranial Nerve ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Focus Of Infection

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

Lower Skull Base: Anatomic Study with Surgical Implications

1995 ◽  
Vol 104 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Essam Saleh ◽  
Maged Naguib ◽  
Yasar Cokkeser ◽  
Miguel Aristegui ◽  
Mario Sanna
Keyword(s):  
Connective Tissue ◽  
Skull Base ◽  
Fibrous Tissue ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Microsurgical Anatomy ◽  
Anatomic Study ◽  
Hypoglossal Canal ◽  
Lower Cranial Nerves

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.

scholarly journals Jugular Foramen Tumors

2011 ◽  
Vol 3 (1) ◽  
pp. 15-23 ◽  
Author(s):  
C Rayappa
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Radical Resection ◽  
Jugular Foramen ◽  
Cranial Base ◽  
Lower Cranial Nerve ◽  
Radiological Features ◽  
Lower Cranial Nerves

ABSTRACT Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. These tumors have characteristic radiological features. Radical resection of these tumors with preservation of the lower cranial nerves is the treatment of choice. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge.

Hemangiopericytoma of the Skull Base and Collet-Sicard Syndrome: A Case Report

1995 ◽  
Vol 74 (12) ◽  
pp. 845-847 ◽  
Author(s):  
F. Comacchio ◽  
R. D'Eredità ◽  
E. Poletto ◽  
A. Poletti ◽  
C. Marchiori
Keyword(s):  
Differential Diagnosis ◽  
Skull Base ◽  
Clinical Course ◽  
Cranial Nerves ◽  
Diagnostic Procedures ◽  
Final Diagnosis ◽  
Jugular Foramen ◽  
Long Period ◽  
Elapsed Time ◽  
Capillary Walls

Hemangiopericytoma (HP) is a mesenchymal tumor that originates from the pericytes of the capillary walls. This is a rare neoplasm, particularly in the head and neck; the skull base is involved exceptionally. We report a case of a large HP located in the jugular foramen. The last four cranial nerves were involved, causing a Collet-Sicard syndrome associated with facial palsy. Only one case of HP and Collet-Sicard syndrome is reported in the literature. The clinical course of the disease is described, emphasizing the long period of elapsed time between onset of the complaints and the final diagnosis. Diagnostic procedures and immunohistochemical evaluation are analyzed, along with the possible differential diagnosis with other pathological processes that more frequently involve the jugular foramen.

Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges in Atypical Presentation

2005 ◽  
Vol 133 (1) ◽  
pp. 121-125 ◽  
Author(s):  
Amar Singh ◽  
Mazin Al Khabori
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Cranial Nerves ◽  
Contralateral Side ◽  
Lateral Sinus ◽  
Skull Base Osteomyelitis ◽  
Atypical Symptoms ◽  
Malignant Otitis Externa ◽  
Atypical Manifestations

OBJECTIVE: We sought to document the diagnostic and management difficulties in masked skull base osteomyelitis secondary to malignant otitis externa, with emphasis on establishing diagnostic criteria in recurrence. STUDY DESIGN: Retrospective analysis of 3 cases of inadequately treated malignant otitis externa in elderly diabetic individuals leading to recurrence and atypical manifestations of skull base osteomyelitis on contralateral side with or without multiple cranial nerve involvement. RESULTS: Two of the 3 cases died of the disease despite aggressive treatment. One case was treated successfully with combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric oxygen therapy. Major complications such as thrombosis of lateral sinus and internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine erosion and paralysis of all cranial nerves with exception of Ist cranial nerve were observed. CONCLUSION: There is high morbitity and mortality associated with skull base osteomyelitis. In partially treated cases of malignant otitis externa, atypical symptoms and findings of unilateral severe otalgia, unremitting headache, and presence of high ESR, unilateral OME, constitute diagnostic clues of skull base osteomyelitis. Such cases require further investigation with CT, MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.

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