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Aguilera-Pena MP, Castiblanco MA, Osejo-Arcos V, Aponte-Caballero R, Gutierrez-Gomez S, Abaunza-Camacho JF, Guevara-Moriones N, Benavides-Burbano CA, Riveros-Castillo WM, Saavedra JM. Collet-Sicard syndrome: a scoping review. Neurosurg Rev 2023; 46:244. [PMID: 37707587 DOI: 10.1007/s10143-023-02145-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
Collet-Sicard syndrome (CSS) is the unilateral palsy of the cranial nerves (CN) IX, X, XI, and XII. To our knowledge, no review describes the characteristics of patients diagnosed with CSS. Therefore, this review aims to collect and describe all cases in the literature labeled as CSS. We performed a scoping review of the literature and conducted a database search in Embase and PubMed. We included articles and abstracts with case reports or case series of patients with CSS diagnosis. We classified the cases into two groups: "CSS", referring to patients presenting exclusively with IX-XII nerve involvement, and "CSS-plus", which corresponds to cases with CSS and other neurological impairments. We included 135 patients from 126 articles, of which 84 (67.7%) were male. The most common clinical manifestations reported were dysphagia and dysphonia. The most common etiology was tumoral in 53 cases (39.6%) and vascular in 37 cases (27.6%). The majority of patients showed partial or total improvement, with just over half receiving conservative treatment. The most frequent anatomic space was the jugular foramen (44.4%) and the parapharyngeal retrostyloid space (28.9%). Approximately 21% of the patients had other CN impairments, with the seventh and eighth CN most frequently compromised. We conclude that although there is a need for greater rigor in CSS reporting, the syndrome has a clear utility in identifying the localization of jugular foramen and parapharyngeal retrostyloid space pathology.
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Affiliation(s)
| | - Maria A Castiblanco
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Valentina Osejo-Arcos
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Rafael Aponte-Caballero
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Santiago Gutierrez-Gomez
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Juan Felipe Abaunza-Camacho
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | | | - Camilo Armando Benavides-Burbano
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - William M Riveros-Castillo
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Javier M Saavedra
- Center for Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Samaritana, Bogotá, Colombia
- Neurosurgery Department, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
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Robinson C, Maraj D, Minhas JS, Bhatia M, Kak V. Gradenigo's Syndrome and Vernet Syndrome as Presenting Signs of Nasopharyngeal Carcinoma. Cureus 2023; 15:e41636. [PMID: 37565094 PMCID: PMC10411312 DOI: 10.7759/cureus.41636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Both Gradenigo's syndrome and Vernet syndrome are rare pathologies of the intracranial space; both involve compression of a particular anatomic location in the skull, thus affecting structures nearby or within that space. A patient presenting with one or both of these syndromes should raise concern for malignancy, head trauma, or an intracranial infection. We present a case of a 39-year-old female with three weeks of left-sided ear, face, and neck pain along with difficulty swallowing and reduced vision in the left eye. Magnetic resonance imaging of the brain revealed fullness in the left nasopharyngeal region, raising concern for malignancy or infection. Biopsy of the mass ultimately revealed Epstein-Barr virus positive nasopharyngeal carcinoma, nonkeratinizing undifferentiated type, along with culture data revealing methicillin-resistant Staphylococcus aureus positive left otomastoiditis. She received chemoradiation therapy along with six weeks of antibiotic therapy. A patient presenting with symptoms reflective of a sinus infection unrelieved by antibiotics with concomitant cranial nerve deficits should raise clinical concern for an intracranial pathology rather than a simple case of sinusitis.
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Affiliation(s)
- Ciji Robinson
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Diva Maraj
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Jasdeep S Minhas
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | | | - Vivek Kak
- Infectious Disease, Henry Ford Health System, Jackson, USA
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Ota Y, Curaudeau G, Liao E, Bapuraj J, Baba A, Shah G, Srinivasan A. Precise differentiation between jugular foramen paragangliomas and metastases: utility of diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging. Neuroradiology 2023; 65:805-813. [PMID: 36635515 DOI: 10.1007/s00234-023-03113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE This study tested the utility of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE-MRI) in differentiating paragangliomas and metastases in the jugular foramen in combination with conventional imaging. METHODS Forty-nine consecutive patients with paragangliomas or metastases between January 2015 and April 2022 were included in this retrospective study. All patients had pretreatment DWI and DCE-MRI. Between paragangliomas and metastases, normalized apparent diffusion coefficient (nADCmean) and DCE-MRI parameters were compared along with conventional imaging features (enhancement pattern, presence of flow voids, cystic/necrotic change, and bone erosion). The diagnostic performance was tested using receiver operating characteristic (ROC) analysis. RESULTS Thirty-five paragangliomas (5 male; median 49 years) and 14 metastases (9 male; median 61 years) were analyzed. The most common 3 primary cancers included 4 lung cancers, 3 breast cancers, and 3 melanomas. The presence of flow void was significantly different between paragangliomas and metastases (21/35 vs 2/14; P = 0.0047) in conventional imaging features, while fractional plasma volume (Vp) was significantly different between the two tumor types (median 0.46 vs 0.19; P < 0.001) in DWI and DCE-MRI parameters. The areas under the ROC curves (AUCs) of the presence of flow void and Vp were 0.72 and 0.93, respectively. The AUC of the combination of the presence of flow void and Vp was 0.95 and significantly improved compared to that of the presence of flow void (P < 0.001). CONCLUSION Adding DCE-MRI to the head and neck protocol can aid in the precise differentiation between jugular foramen paragangliomas and metastases.
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Affiliation(s)
- Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA.
| | - Guillaume Curaudeau
- Department of Radiology, The University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Eric Liao
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Jayapalli Bapuraj
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Gaurang Shah
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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Ruaux C, Champion CP, Pemberton S, Munday JS. Vernet’s syndrome (jugular foramen syndrome) secondary to osteoma of the tympanic bulla in a young male dog. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Craig Ruaux
- School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
| | | | - Sarah Pemberton
- School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
| | - John S Munday
- School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
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Ciavarro G, Bozzetti F, Falcioni M. Jugular Foramen Metastasis from Lung Cancer: A Case of "A Mass without His Syndrome". J Int Adv Otol 2019; 15:469-471. [PMID: 31257193 DOI: 10.5152/iao.2019.6540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Jugular foramen (JF) metastasis is rare and often presents as JF syndrome. A 73-year-old male complained of left-sided mastoid pain that irradiated to the neck since the past 3 months. Onset of facial nerve (FN) palsy and persistence of the symptomatology despite corticosteroid therapy demanded radiologic evaluation. Computed tomography and magnetic resonance imaging showed a wide osteolytic lesion of the left JF with involvement of the third segment of the FN. The patient underwent transmastoid incisional biopsy. Histopathological examination showed an adenocarcinoma that was suggested to be of respiratory origin. A primary pulmonary lesion and metastasis to other sits were detected. The patient died 1 month after the initiation of the chemotherapy. Persistent mastoid pain and progressive FN palsy must be considered indicative of JF malignant lesions. Despite early diagnosis, secondary lesions of the JF are characterized by a poor prognosis; however, accurate diagnosis may avoid unnecessary aggressive surgery.
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Affiliation(s)
- Giovanni Ciavarro
- Department of Medicine and Surgery, Unit of Otolaryngology and Otoneurosurgery, University-Hospital of Parma, Parma, Italy
| | - Francesca Bozzetti
- Department of Medicine and Surgery, Unit of Neuroradiology, University-Hospital of Parma, Parma, Italy
| | - Maurizio Falcioni
- Department of Medicine and Surgery, Unit of Otolaryngology and Otoneurosurgery, University-Hospital of Parma, Parma, Italy
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Metastatic Adenocarcinoma of Temporal Bone with Collet-Sicard Syndrome. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2018; 30:361-364. [PMID: 30560103 PMCID: PMC6291818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Metastatic tumors of the temporal bone are extremely rare. Collet-Sicard syndrome is an uncommon condition characterized by unilateral palsy of the lower four cranial nerves. The clinical features of temporal bone metastasis are nonspecific and mimic infections such as chronic otitis media and mastoiditis. CASE REPORT This report describes a rare case of metastatic adenocarcinoma of the temporal bone causing Collet-Sicard syndrome, presenting with hearing loss, headache and ipsilateral cranial nerve palsies. The patient was a 68-year old woman initially diagnosed with extensive mastoiditis and later confirmed as having metastatic adenocarcinoma of the temporal bone, based on histopathologic findings. CONCLUSION Clinical presentation of metastatic carcinoma of the temporal bone can be overshadowed by infective or inflammatory conditions. This case report is to emphasize the point that a high index of clinical suspicion is necessary for the early diagnosis of this aggressive disease which carries relatively poor prognosis. This report highlights that it is crucial to suspect malignant neoplasm in patients with hearing loss, headache and cranial nerve palsies.
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Edwards B, Wang JM, Iwanaga J, Loukas M, Tubbs RS. Cranial Nerve Foramina: Part II - A Review of the Anatomy and Pathology of Cranial Nerve Foramina of the Posterior Cranial Fossa. Cureus 2018; 10:e2500. [PMID: 29928560 PMCID: PMC6005399 DOI: 10.7759/cureus.2500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/12/2018] [Indexed: 11/26/2022] Open
Abstract
Cranial nerve foramina are integral exits from the confines of the skull. Despite their significance in cranial nerve pathologies, there has been no comprehensive anatomical review of these structures. Owing to the extensive nature of this topic we have divided our review into two parts; Part II, presented here, focuses on the foramina of the posterior cranial fossa and discusses each foramen's shape, orientation, size, surrounding structures, and structures that pass through it. Furthermore, by comparing foramen sizes against the cross-sectional areas of their contents, we determine the amount of free space available within each. We also review lesions that can obstruct each foramen and discuss the clinical consequences.
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Affiliation(s)
- Bryan Edwards
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George, GRD
| | - Joy Mh Wang
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George, GRD
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George, GRD
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Abstract
Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.
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Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, University of Virginia, Charlottesville, VA, United States.
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Sánchez-Larsen A, Feria-Vilar I, Collado R, Segura T. Collet–Sicard syndrome caused by metastasis. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Clinical and Electromyographic Characteristics of Unilateral Vocal Fold Paralysis With Lower Cranial Nerve Injury. J Voice 2017; 31:126.e1-126.e6. [DOI: 10.1016/j.jvoice.2015.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/24/2015] [Indexed: 11/18/2022]
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Collet-Sicard syndrome caused by metastasis. Neurologia 2015; 32:399-401. [PMID: 26607865 DOI: 10.1016/j.nrl.2015.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 11/24/2022] Open
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Flis DW, Shah AT, Tracy JC, Heilman CB, O'Leary MA. Metastatic breast carcinoma of the jugular foramen: a rare case of Villaret syndrome. Head Neck 2015; 37:E146-9. [PMID: 25586658 DOI: 10.1002/hed.24008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The differential diagnosis of skull base masses is diverse and includes benign and malignant neoplasms, vascular anomalies, congenital lesions, as well as infectious and inflammatory processes. Metastatic masses of the skull base are a rare manifestation of systemic malignancies. Breast cancer is the most common cause of skull base metastases. Villaret syndrome refers to cranial nerves IX, X, XI, and XII and sympathetic chain neuropathies. It is a clinical subtype of jugular foramen syndromes. METHODS AND RESULTS A 62-year-old woman with a history of breast carcinoma presented with hoarseness dating to shortly after her mastectomy years earlier. CT angiography showed enhancing tissue just outside the right jugular foramen, and biopsy confirmed metastatic adenocarcinoma consistent with breast cancer. CONCLUSION Villaret syndrome caused by breast cancer metastases has not been previously described. We present a case of Villaret syndrome caused by metastasis of invasive breast adenocarcinoma and a review of the literature of metastases of breast cancer to the skull base.
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Affiliation(s)
- Daniel W Flis
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Ameer T Shah
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Jeremiah C Tracy
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Carl B Heilman
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Miriam A O'Leary
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
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Thomas AJ, Wiggins RH, Gurgel RK. Nonparaganglioma Jugular Foramen Tumors. Otolaryngol Clin North Am 2015; 48:343-59. [DOI: 10.1016/j.otc.2014.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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