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

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.

Morphological and Morphometric study of Jugular Foramen in human dry skull of Eastern Indian origin: An Anatomical Investigation

Background: Jugular foramen (JF) is one of the complex foramen present in base of skull. It varies in shape and size from side to side in same cranium, in different cranium and in different races. It is associated with many diseases of posterior cranial fossa and many skull base surgeries are being carried out by drilling the skull bone around JF for better exposure. Aim and objectives: The present study aims to carry out the morphological and morphometric analysis of jugular foramen of skulls of eastern Indian origin. Materials and Methods: The study was carried out on 100 JF of 50 dried human skulls. Anteroposterior(width), medio-lateral diameter(length) of JF, width and depth of the jugular fossa were measured. Mean and standard deviation of different measurements of left and right side were statistically analysed by student’s t-test. Presence of dome and septum were also studied. Results: The mean of all the measurements are more on right side than left side but it is statistically insignificant (p>0.05). Bony septum was found in 76% cases on left side and 60% on right side. Complete septation wasn’t found in our study. Domed roof was present in 66% cases on right side as compared to 52% on left side. Conclusion: Shape and size of JF may vary due to different size of internal jugular vein and it’s superior bulb. These variations can be due to constitutional, racial or genetic. This anatomical knowledge of JF may help the neurosurgeons, ENT surgeons and radiologists during their clinical exploration.

REDUCTION OF OXIDATIVE STRESS OF PULMONARY MEMBRANES DURING LYMPHOTROPIC ADMINISTRATION OF ISONIAZID

The article presents the results of a clinical study of the severity of oxidative stress in the treatment with isoniazid on the material of bronchoalveolar flushes. The object of the study was patients with infiltrative pulmonary tuberculosis who had their bronchoalveolar lavage (BAS) removed during FBS. 19 patients received lymphotropic administration of isoniazid (group 1), 21 patients received intramuscular injection of isoniazid by needle-jet method (group 2), 20 patients were in the 3rd control group with traditional intramuscular administration of isoniazid as part of standard 4 ABP regimens. Lymphotropic injections were performed sequentially in the area of the jugular fossa, behind the xiphoid process, and in the parasternal zone. Group 2 patients were injected with a 10% isoniazid solution in an amount of 1.0 ml into the intercostal space in the projection of the inflammatory focus using a semi-automatic combined ISI-1 acupuncture injector. The content of total protein, malondialdehyde (the final product of lipid peroxidation) and isonicotinic acid hydrazide (non-metabolized GINK, which is part of the anti-tuberculosis drug isoniaziada) was studied in BAS using biochemical methods. Total protein and MDA in patients with tuberculosis are at a high level, reflect the intensity of inflammation and decrease with lymphotropic and intra-pulmonary administration of isoniazid. The content of GINK in BAS is higher with its lymphotropic administration. Based on the study of these tests and the content of GINK in bronchoalveolar flushes, it can be argued that local and regional lymphotropic administration of isoniazid has a greater anti-inflammatory effect on the membranes of the lungs and tracheobronchial tree than intramuscular administration.

Paragangliomas of the Head and Neck: A Practical Approach to Diagnosis and Review of Detailed Anatomy of Sites of Origin

Paragangliomas are slow-growing hypervascular neuroendocrine tumors that arise from neural crest paraganglia cells distributed throughout the body. The purpose of this article is to review the clinical presentation and imaging characteristics of paragangliomas of the head and neck, based on their sites of origin, and to discuss the differential diagnosis of lesions that can mimic them. This article also reviews detailed anatomy of the jugular fossa, temporal bone, and the carotid space, where most head and neck paragangliomas are found. This article is intended for neuroradiologists and neuroradiology trainees with varying degrees of experience as well as a broader audience of physician radiologists and nonradiologists who use imaging of the head and neck in their daily practice.Learning Objective: To recognize the clinical presentation and imaging characteristics of paragangliomas of the head and neck, based on their sites of origin, and to differentiate these tumors from lesions that can mimic them.

Morphometric Study of Jugular Foramen and Jugular Fossa of Dried Adult Human Skulls and Its Clinical Significance

Introduction Jugular foramen is one of the most fascinating foramina of the human skull. It is a complex, irregular bony canal located between the occipital bone and petrous part of the temporal bone. Many important structures, like 9th, 10th, 11th cranial nerves, meningeal branch of occipital and ascending pharyngeal arteries, internal jugular vein, and inferior petrosal sinus, are passing through it. The jugular fossa has a septum and a dome. The septum divides the foramen into two compartments: anteromedial compartment (pars nervosa) and posterolateral compartment (pars vascularis). The dome contains superior bulb of internal jugular vein. The architecture of the foramen varies in size, shape, and laterality besides differences related to sex and race. The morphometric measurements of jugular foramen are very important for neurosurgeries and head and neck surgeries. Objectives The aim of the present study is to study the morphology of jugular foramen along with its dimensions, compartments, presence of partial or complete septa and dome. Materials and Methods A total number of 60 jugular foramina were examined from 30 adult dry human skulls of unknown age and sex from the Department of Anatomy, PSG Institute of Medical Sciences and Research, Coimbatore. Measurements were taken using Digital Vernier calipers. Results were analyzed statistically. Results The length, width, and surface area of jugular foramen of right side were measured and compared with the left side. Length and width of the jugular foramen was significantly higher on the right side. The presence of partial septum was found in 27 skulls (90%) on the right side and 29 skulls (99.7%) on the left side, respectively. Dome was present in 100% of the jugular foramina on the right side and 90% of the jugular foramina on the left side. Separate opening for inferior petrosal sinus was found in eight skulls (27%) on the right side and four skulls (13%) on the left side. Conclusion This study provides a clear understanding of anatomy of jugular foramen and supports the reported morphometric variations. The morphometric variations of jugular foramen in the parameters of the skull are probably due to ethnic and racial factors. Knowledge of these variations is important for neurosurgeons and radiologists who deal with space occupying lesions of the structures surrounding jugular foramen. This study may be helpful for ENT surgeons while performing middle ear surgeries.

MORPHOMETRIC STUDY OF THE JUGULAR FORAMEN IN DRY NIGERIAN SKULLS. Estudio morfométrico del foramen yugular en cráneos nigerianos secos

Jugular foramen is a hiatus in the posterior cranial fossa that transmits the internal jugular vein among other structures. The knowledge of the jugular foramen is important in neurosurgical procedures. The objective of the study was to characterize the morphology and the dimensions of jugular foramen in dry Nigerian skulls. One hundred and seventy jugular foramens from 85 dry adult skulls of unknown sex were studied. Morphology was studied by observation and measurements were taken with Venier caliper. The parameters that were studied included the shape, septation, medio-lateral diameter, antero-posterior diameter of jugular foramen, and the dome, width and depth of jugular fossa. Oval shaped foramen (77%) was more prevalent than round shaped foramen (23%). Complete septation was found in 19.4% of skulls, while incomplete septation was found in 41.2% of skulls. Absence of septation was found in 39,4% of skulls. Dome over the jugular fossa was present in 67,6% and absent in 32,4% of the skulls. The antero-posterior diameter (right - 13,20mm±2.8, left - 11,72±2.8) and medio-lateral diameter (right – 18.73mm±3.5, left – 17,33mm±3.1) were significantly higher on the right side than on the left side. The depth of jugular fossa was significantly higher on the right side (12.38mm±2.4) than on the left side (10.95mm±2.8). The width of jugular fossa was higher on the right (12.06mm±3.6) than on the left (11.80mm±3.3) but the difference was not significant. The present study demonstrated right sided dominance in the metric parameters of the jugular foramen in our environment. El foramen yugular es un hiato en la fosa craneal posterior que transmite la vena yugular interna entre otras estructuras. El conocimiento del foramen yugular es importante en procedimientos neuro-quirúrgicos. El objetivo del estudio era caracterizar la morfología y las dimensiones del foramen yugular en cráneos nige-rianos secos. Cientos y setenta forámenes yugulares a partir de 85 cráneos secos del adulto de sexo desconocido fueron estudiados. La morfología fue estudiada por la observación y las medidas fueron tomadas con el calibrador de Vernier. Los parámetros que fueron estudiados incluyeron la forma, la tabicación, el diámetro medio-lateral, el diámetro anteroposterior del foramen yugular, y la bóveda, la anchura y la profundidad de la fosa yugular. El agujero de forma oval (el 77%) era más frecuente que el agujero de forma redonda (23%). La tabicación completa fue encontrada en 19,4% de cráneos, mientras que la tabicación incompleta fue encontrada en 41,2% de cráneos. La ausencia de tabicación fue encontrada en 39,4% de cráneos. La bóveda sobre la fosa yugular estaba presente en 67,6% y ausente en 32,4% de los cráneos. El diámetro anteroposterior (derecho: 13,20 mm±2,8, izquierdo: 11,72±2,8) y el diámetro medio-lateral (derecho: 18,73mm ±3,5, izquierdo: 17,33mm±3,1) eran perceptiblemente más altos en el derecho que en el lado izquierdo. La profundidad de la fosa yugular era perceptiblemente más alta en el derecho (12,38mm±2,4) que en el lado izquierdo (10,95mm±2,8). La anchura de la fosa yugular era más alta en la derecha (12,06mm±3,6) que a la izquierda (11,80mm±3,3) pero la diferencia no era significativa. El actual estudio demostró la dominación del lado derecho en los parámetros métricos del foramen yugular en nuestro medio.