scholarly journals The microsurgical anatomy of the glossopharyngeal nerve with respect to the jugular foramen lesions

2004 ◽  
Vol 17 (2) ◽  
pp. 12-21 ◽  
Author(s):  
Mehmet Faik Özveren ◽  
Uđur Türe
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Glossopharyngeal Nerve ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Anatomical Landmarks ◽  
Related Area ◽  
Deep Layers ◽  
Lower Cranial Nerves

Removal of lesions involving the jugular foramen region requires detailed knowledge of the anatomy and anatomical landmarks of the related area, especially the lower cranial nerves. The glossopharyngeal nerve courses along the uppermost part of the jugular foramen and is well hidden in the deep layers of the neck, making this nerve is the most difficult one to identify during surgery. It may be involved in various pathological entities along its course. The glossopharyngeal nerve can also be compromised iatrogenically during the surgical treatment of such lesions. The authors define landmarks that can help identify this nerve during surgery and discuss the types of lesions that may involve each portion of the glossopharyngeal nerve.

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 Disease of lower cranial nerves caused by vascular compression

2008 ◽  
Vol 55 (2) ◽  
pp. 27-31 ◽  
Author(s):  
B.D. Antic ◽  
P. Peric ◽  
S.Lj. Stefanovic
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Postoperative Outcome ◽  
Glossopharyngeal Neuralgia ◽  
Statistic Analysis ◽  
Vascular Compression ◽  
Excellent Outcome ◽  
Surgical Options ◽  
Lower Cranial Nerves ◽  
Surgical Option

Between April 1989 and September 2007, 181 patients with disease of lower cranial nerves (DLCN) underwent posterior fossa exploration. As a cause of DLCN, vascular compression (VC) was present in 89 patients with trigeminal neuralgia (TN), in 6 with hemifacial spasm (HFS), in 1 with glossopharyngeal neuralgia, in 1 with Meniere?s disease, and in 5 with multiple DLCN. Depending on intraoperative findings, different surgical options were used: microvascular decompression (MVD), MVD with partial sensory rhizotomy (PSR) or total sensory rhizotomy (TSR). Statistic analysis was made using the Fisher?s exact 2-side test. In patients with TN, excellent outcome was archived in 83 patients and good in 6. Postoperative outcome was better (p = 0.007) in cases with severe VC, but without significant correlation between used surgical option and outcome (p = 0.402). Frequency rate of relapses did not depend on severity of VC (p = 0.502) and used surgical option (p = 0.175). In 6 patients with HFS, excellent outcome was archived in 5 with arterial compression and poor in 1 with venous contact. In patients with Meniere?s disease and glossopharyngeal neuralgia, MVD result with excellent outcome. In 5 patients with multiple DLCN, excellent outcome was archived in 3 and good in 2. MVD is method of choice in surgical treatment of DLCN caused by VC. Overall outcome is better with severity of VC.

Anatomic Landmarks of the Glossopharyngeal Nerve: A Microsurgical Anatomic Study

Neurosurgery ◽  
2003 ◽  
Vol 52 (6) ◽  
pp. 1400-1410 ◽  
Author(s):  
M. Faik Özveren ◽  
Uğur Türe ◽  
M. Memet Özek ◽  
M. Necmettin Pamir
Keyword(s):  
Choroid Plexus ◽  
Fourth Ventricle ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Transverse Process ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Glossopharyngeal Nerve ◽  
Lateral Recess ◽  
Cochlear Aqueduct

Abstract OBJECTIVE Compared with other lower cranial nerves, the glossopharyngeal nerve (GPhN) is well hidden within the jugular foramen, at the infratemporal fossa, and in the deep layers of the neck. This study aims to disclose the course of the GPhN and point out landmarks to aid in its exposure. METHODS The GPhN was studied in 10 cadaveric heads (20 sides) injected with colored latex for microsurgical dissection. The specimens were dissected under the surgical microscope. RESULTS The GPhN can be divided into three portions: cisternal, jugular foramen, and extracranial. The rootlets of the GPhN emerge from the postolivary sulcus and course ventral to the flocculus and choroid plexus of the lateral recess of the fourth ventricle. The nerve then enters the jugular foramen through the uppermost porus (pars nervosa) and is separated from the vagus and accessory nerves by a fibrous crest. The cochlear aqueduct opens to the roof of this porus. On four sides in the cadaver specimens (20%), the GPhN traversed a separate bony canal within the jugular foramen; no separate canal was found in the other cadavers. In all specimens, the Jacobson's (tympanic) nerve emerged from the inferior ganglion of the GPhN, and the Arnold's (auricular branch of the vagus) nerve also consisted of branches from the GPhN. The GPhN exits from the jugular foramen posteromedial to the styloid process and the styloid muscles. The last four cranial nerves and the internal jugular vein pass through a narrow space between the transverse process of the atlas (C1) and the styloid process. The styloid muscles are a pyramid shape, the tip of which is formed by the attachment of the styloid muscles to the styloid process. The GPhN crosses to the anterior side of the stylopharyngeus muscle at the junction of the stylopharyngeus, middle constrictor, and hyoglossal muscles, which are at the base of the pyramid. The middle constrictor muscle forms a wall between the GPhN and the hypoglossal nerve in this region. Then, the GPhN gives off a lingual branch and deepens to innervate the pharyngeal mucosa. CONCLUSION Two landmarks help to identify the GPhN in the subarachnoid space: the choroid plexus of the lateral recess of the fourth ventricle and the dural entrance porus of the jugular foramen. The opening of the cochlear aqueduct, the mastoid canaliculus, and the inferior tympanic canaliculus are three landmarks of the GPhN within the jugular foramen. Finally, the base of the styloid process, the base of the styloid pyramid, and the transverse process of the atlas serve as three landmarks of the GPhN at the extracranial region in the infratemporal fossa.

Myeloma Manifesting as a Large Jugular Tumor: Case Report

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 971-977 ◽  
Author(s):  
Shigeru Miyachi ◽  
Makoto Negoro ◽  
Kiyoshi Saito ◽  
Kyoko Nehashi ◽  
Kenichiro Sugita
Keyword(s):  
Case Report ◽  
Osteolytic Lesion ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Arteriovenous Shunting ◽  
Hypervascular Tumor ◽  
Multiple Myelomas ◽  
Lower Cranial Nerves

Abstract The authors report a case of cranial plasmacytoma with multiple myelomas and palsy of the lower cranial nerves. The osteolytic lesion adjacent to the jugular foramen was demonstrated by an angiogram to be exceedingly hypervascular, with arteriovenous shunting resembling that seen in paragangliomas. Forty-five cases of cranial and intracranial plasmacytoma from the literature were reviewed. The findings indicate that a cranial plasmacytoma commonly appears to be a hypervascular tumor, whereas most dural tumors or intraparenchymal tumors have poor vascularity.

scholarly journals Technical strategies to approach aneurysms of the vertebral and posterior inferior cerebellar arteries

2005 ◽  
Vol 19 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Niklaus Krayenbühl ◽  
Carlos A. Guerrero ◽  
Ali F. Krisht
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Anatomical Location ◽  
Microsurgical Anatomy ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Pica Aneurysms ◽  
Lower Cranial Nerves

Object Aneurysms of the vertebral artery (VA) and proximal posterior inferior cerebellar artery (PICA) are rare and challenging lesions, as they are located in front of the brainstem and surrounded by the lower cranial nerves. Many different approaches have been described for their treatment, and have yielded different results. With the use of different examples of lesions, the authors describe their surgical strategy in the management of VA and PICA aneurysms. Methods The far-lateral approach was used, and the potential of its different extensions according to the specific anatomical location and configuration of different types of aneurysms is emphasized. Conclusions With the present knowledge of the microsurgical anatomy in the region of the foramen magnum, the far-lateral approach can be tailored to the specific anatomical and morphological configuration of an aneurysm in this region with good surgical results.

scholarly journals Surgical treatment of glossopharyngeal nerve schwannomas: Results of two-center study (14 patients included) and literature review

2021 ◽  
Vol 27 (4) ◽  
pp. 23-29
Author(s):  
Andrii H. Sirko ◽  
Oleksandr M. Lisianyi ◽  
Оksana Y. Skobska ◽  
Rostislav R. Malyi ◽  
Iryna O. Popovych ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Facial Nerve ◽  
Hearing Impairment ◽  
Cranial Nerves ◽  
Type A ◽  
Jugular Foramen ◽  
Type B ◽  
Tumor Removal ◽  
Type D ◽  
Total Tumor Removal

Objective: This study is aimed to analyze the outcomes of surgical treatment of glossopharyngeal schwannomas based on pre- and postoperative neurological status assessment. Materials and methods: This paper is a retrospective analysis of examination and surgical treatment of 14 patients who were operated on in two large clinics from 2018 to 2021 inclusive. When analyzing the collected data, gender, age, disease symptoms, tumor size and location, surgical approach, tumor to cranial nerves (CN) ratio, jugular foramen (JF) condition, and tumor removal volume were taken into account. All tumors were divided into groups depending on tumor location relative to the JF. Particular attention was paid to assessing cranial nerves functions. Facial nerve function was assessed as per House-Brackmann Scale (HBS), hearing function as per Gardner-Robertson Scale (GRS). Results: 3 (21.4%) patients had total tumor removal: 2 patients had type A tumors and one had type B tumor. Subtotal resection took place in 7 (50%) cases. In 4 cases, a tumor was partially removed: 3 patients had type D tumors and one had type B tumor. 3 (21.4%) patients had preoperative FN deficit (HBS Grade II) and mild dysfunction. 5 (35.7%) patients had postoperative facial nerve deficit: HBS ІІ, 2; ІІІ, 1; V, 2. Preoperative sensorineural type hearing impairment on the affected side was diagnosed in 13 (92.6%) patients. Before surgery, 6 patients had non-serviceable hearing, which remained at the same level after surgery. None of the patients with grade I or II hearing before surgery had any hearing impairment postoperatively. In 2 (14.3%) cases, hearing improved from grade V to grade III after surgery. 6 (42.9%) patients developed new neurological deficit in the caudal group CN. Postoperative deficit of the caudal group CN occurred in type D tumors in 3 patients, type A tumors 2 patients, and type B tumors one patient. Conclusions: Applying a retrosigmoid approach only makes it possible to achieve total tumor removal in case of type A tumors. To remove other tumor types, it is necessary to select approaches that enable access to the jugular foramen and infratemporal fossa. Intraoperative neurophysiological monitoring is an extremely important tool in glossopharyngeal schwannoma surgery. The most common postoperative complication is a developed or increased deficit of the caudal CN group, which can lead to persistent impairments in the patients’ quality of life. Preservation of the CN VII and VIII function in most cases is a feasible task and shall be ensured as a standard for this pathology.

Carotid fibromuscular dysplasia and paresis of lower cranial nerves (Collet-Sicard syndrome)

1982 ◽  
Vol 56 (6) ◽  
pp. 850-853 ◽  
Author(s):  
Ulf Havelius ◽  
Bengt Hindfelt ◽  
Jan Brismar ◽  
Sten Cronqvist
Keyword(s):  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Clinical Symptoms ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Acute Onset ◽  
Content Type ◽  
Lower Cranial Nerves ◽  
Base Of The Skull ◽  
Symptoms And Signs

✓ A patient suffered the acute onset of unilateral pareses of the ninth through 12th cranial nerves (Collet-Sicard syndrome). Ipsilateral retrograde jugular phlebography and carotid angiography revealed irregular aneurysmal changes of the internal carotid artery at the base of the skull, causing compression of the internal jugular vein below the jugular foramen. This finding is discussed in relation to the clinical symptoms and signs, and possible mechanisms are examined. Family history as well as the clinical and roentgenological findings were compatible with a diagnosis of fibromuscular dysplasia.

scholarly journals Late Pseudo-Exacerbation of Myasthenia Gravis Due to Ectopic Thymoma Invading Lower Cranial Nerves

1990 ◽  
Vol 17 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Gregg MacLean ◽  
Alan Guberman ◽  
Antonio Giulivi
Keyword(s):  
Myasthenia Gravis ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Cervical Mass ◽  
Ectopic Thymoma ◽  
Cranial Nerve Palsies ◽  
Lower Cranial Nerves ◽  
Repeated Aspiration

ABSTRACT:Dysarthria, dysphagia and repeated aspiration in a 54-year-old woman diagnosed and treated for myasthenia gravis 7 years earlier were initially thought to represent a late exacerbation of myasthenia. A cervical mass invading the jugular foramen and causing multiple lower cranial nerve palsies was biopsied and found to represent invasive ectopic thymoma.

The Juxtacondylar Approach to the Jugular Foramen

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS75-ONS81 ◽  
Author(s):  
Michaël Bruneau ◽  
Bernard George
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerves ◽  
Transverse Process ◽  
Petrous Bone ◽  
Jugular Foramen ◽  
External Carotid ◽  
Anterolateral Approach ◽  
Bone Drilling ◽  
The Third ◽  
Lower Cranial Nerves

Abstract Objective: We sought to describe the juxtacondylar approach to jugular foramen tumors. Methods: Through an anterolateral approach, the third segment of the vertebral artery (between C2 and the dura mater) is controlled. The C1 transverse process of the atlas, which is located just inferiorly to the jugular foramen, is then removed. The dissection of the internal jugular vein is performed as high as possible, with control of the IXth, Xth, XIth, and XIIth cranial nerves. If required by a tumor extending into the neck, the internal and external carotid arteries can be exposed and controlled. Through a partial mastoidectomy and after removal of the bone covering the jugular tubercle, the end of the sigmoid sinus and then the posteroinferior part of the jugular foramen are reached. RESULTS: This technique is efficient to expose tumors extending into the jugular foramen. Contrary to the infratemporal approach, it has the main advantage of avoiding petrous bone drilling and associated potential complications. Lower cranial nerves are well exposed in the neck. In patients with schwannomas, complete resection with selective dividing of only the few involved rootlets can be achieved. Conclusion: The juxtacondylar approach is an efficient approach to tumors located in the jugular foramen. It necessitates control of the third segment of the vertebral artery but has the advantage of avoiding complications associated with petrous bone drilling. Extension beyond the jugular foramen requires combination with an infratemporal or a retrosigmoid approach.

The microsurgical anatomy of the jugular foramen

1995 ◽  
Vol 83 (5) ◽  
pp. 903-909 ◽  
Author(s):  
S. Adetokunboh Ayeni ◽  
Kenji Ohata ◽  
Kiyoaki Tanaka ◽  
Akira Hakuba
Keyword(s):  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
The Right ◽  
Posterior Meningeal Artery ◽  
Distal Sigmoid

✓ 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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