1
|
Sriamornrattanakul K, Akharathammachote N, Chonhenchob A, Mongkolratnan A, Niljianskul N, Phoominaonin IS, Ariyaprakai C. Far-lateral approach without C1 laminectomy for microsurgical treatment of vertebral artery and proximal posterior inferior cerebellar artery aneurysms: Experience from 48 patients. World Neurosurg X 2023; 19:100216. [PMID: 37251244 PMCID: PMC10209739 DOI: 10.1016/j.wnsx.2023.100216] [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] [Received: 11/23/2022] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
Background In the endovascular era, most of vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms were mainly treated with endovascular procedures. This study aimed to demonstrate the microsurgical treatment via the far-lateral approach without C1 laminectomy and its clinical outcomes. Methods Forty-eight patients with VA and proximal PICA aneurysms treated by microsurgery through the far-lateral approach without C1 laminectomy, between January 2016 and June 2021, were retrospectively evaluated. Results Most patients (87.5%) presented with subarachnoid hemorrhage. Grading at presentation was poor in 41.7%. The rates of VA dissecting aneurysms, saccular aneurysms of the VA-PICA junction, and true PICA saccular aneurysms were 54.2, 18.7, and 14.6%, respectively. All aneurysms were located above the lower margin of the foramen magnum. The far-lateral approach without C1 laminectomy was successfully used in all patients without residual aneurysms. Various surgical strategies were applied depending on the characteristics of the aneurysm. Good outcomes 3 months postoperatively were achieved in 77.1% and 89.3% for the overall and good-grade groups, respectively. Conclusions Microsurgery is a safe and effective treatment of VA and proximal PICA aneurysms. Moreover, the far-lateral approach without C1 laminectomy was adequate and effective for aneurysms located above the lower border of the foramen magnum.
Collapse
|
2
|
Juelke E, Butzer T, Yacoub A, Wimmer W, Caversaccio M, Anschuetz L. Assessment of jugular bulb variability based on 3D surface models: quantitative measurements and surgical implications. Surg Radiol Anat 2023; 45:315-319. [PMID: 36732380 PMCID: PMC9981494 DOI: 10.1007/s00276-023-03087-x] [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] [Received: 03/30/2022] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE High-riding jugular bulbs (JBs) among other anatomical variations can limit surgical access during lateral skull base surgery or middle ear surgery and must be carefully assessed preoperatively. We reconstruct 3D surface models to evaluate recent JB classification systems and assess the variability in the JB and surrounding structures. METHODS 3D surface models were reconstructed from 46 temporal bones from computed tomography scans. Two independent raters visually assessed the height of the JB in the 3D models. Distances between the round window and the JB dome were measured to evaluate the spacing of this area. Additional distances between landmarks on surrounding structures were measured and statistically analyzed to describe the anatomical variability between and within subjects. RESULTS The visual classification revealed that 30% of the specimens had no JB, 63% a low JB, and 7% a high-riding JB. The measured mean distance from the round window to the jugular bulb ranges between 3.22 ± 0.97 mm and 10.34 ± 1.41 mm. The distance measurement (error rate 5%) was more accurate than the visual classification (error rate 15%). The variability of the JB was higher than for the surrounding structures. No systematic laterality was found for any structure. CONCLUSION Qualitative analysis in 3D models can contribute to a better spatial orientation in the lateral skull base and, thereby, have important implications during planning of middle ear and lateral skull base surgery.
Collapse
Affiliation(s)
- Eirik Juelke
- Department of Otolaryngology Head and Neck Surgery, Inselspital University Hospital and University of Bern, Bern, Switzerland.,Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Tobias Butzer
- Department of Otolaryngology Head and Neck Surgery, Inselspital University Hospital and University of Bern, Bern, Switzerland.,Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Abraam Yacoub
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wilhelm Wimmer
- Department of Otolaryngology Head and Neck Surgery, Inselspital University Hospital and University of Bern, Bern, Switzerland.,Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otolaryngology Head and Neck Surgery, Inselspital University Hospital and University of Bern, Bern, Switzerland.,Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otolaryngology Head and Neck Surgery, Inselspital University Hospital and University of Bern, Bern, Switzerland. .,Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland.
| |
Collapse
|
3
|
Aberrant drainage of posterior condylar emissary vein and abnormal orifice of hypoglossal canal: surgical implications in the transcondylar fossa approach for VA-PICA junction aneurysm. Acta Neurochir (Wien) 2022; 164:2119-2126. [PMID: 35701645 DOI: 10.1007/s00701-022-05263-1] [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: 10/21/2021] [Accepted: 05/18/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The posterior condylar emissary vein (PCEV) and posterior condylar canal (PCC) are anatomical landmarks for identifying important structures like jugular tubercle and occipital condyle in surgical approach to the foramen magnum and condylar fossa. Several anatomical variations have been described. Drainage into the jugular bulb is found to be commonest. METHOD A 70-year-old patient with unruptured vertebral artery-posterior inferior cerebellar artery (PICA) junction aneurysm-underwent surgical clipping via transcondylar fossa approach. RESULT Preoperative computed tomography demonstrated an abnormal communication existed between the left-sided PCC and hypoglossal canal (HC). The PCEV was identified draining into a dilated venous channel/pouch at the "hip" of sigmoid sinus (junction of sigmoid sinus and jugular bulb). Intra-operatively, an occipital artery-PICA bypass was performed. The PCEV was skeletonized, coagulated, and divided to achieve hemostasis. The lateral and cranial drilling around PCC was successful at safeguarding the underlying contents of HC (in medial and caudal extent). CONCLUSION Preoperative angiography and detailed morphometric analysis of the PCC were helpful in planning surgical approach-identifying and controlling the PCEV, and skeletonization of the PCC without compromising the hypoglossal nerve and anterior condylar emissary vein.
Collapse
|
4
|
Koutsarnakis C, Drosos E, Komaitis S, Mazarakis N, Neromyliotis E, Kalyvas A, Troupis T, Stranjalis G. Introducing the Posterior Condylar Emissary Vein as an Effective Surgical Landmark for Optimizing the Standard Retrosigmoid Approach: An Anatomo-Imaging Study. World Neurosurg 2021; 158:174-179. [PMID: 34863935 DOI: 10.1016/j.wneu.2021.11.118] [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: 10/09/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a lack of definite anatomical landmarks for the inferior extension of the standard retrosigmoid approach. In this study, we evaluated whether the posterior condylar emissary vein (PCEV) can be used as an intraoperative landmark for optimizing the surgical corridor. METHODS We performed the standard retrosigmoid approach on 5 formalin-fixed and latex-injected cadaveric specimens and measured the distance between the PCEV near its bony canal and the vertebral artery (VA). In addition, vascular reconstructions of thin-sliced preoperative computed tomography (CT) scans were studied in 40 patients and the relationship between these 2 vessels was evaluated. An illustrative case is also included. RESULTS The PCEV was consistently identified on both sides of cadaveric specimens and in 87.5% and 82.5% of the left and right sides of the included CT scans, respectively. The average distance between the part of the PCEV near its osseous canal and the VA was measured to be between 8.4 mm and 8.6 mm in the specimens and between 9.2 mm and 9.3 mm in the CT scans. This distance offers a safe and effective plane of dissection during the standard retrosigmoid approach and allows easy access to the foramen magnum. CONCLUSIONS The PCEV near its bony canal proved to be an easy, straightforward, safe, and effective operative landmark with which the surgeon can extend the soft tissue dissection and bony exposure towards the foramen magnum. This maneuver provides ample access to the cisterna magna for cerebrospinal fluid drainage and increases visibility and surgical maneuverability to the entire cerebellopontine angle.
Collapse
Affiliation(s)
- Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Evangelos Drosos
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Mazarakis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Eleftherios Neromyliotis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Athens, Greece; Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Theodore Troupis
- Department of Anatomy, National and Kapodistrian University of Athens, Athens, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
5
|
Sriamornrattanakul K, Akharathammachote N. The Intersection Between the Sternocleidomastoid and Splenius Capitis as the Anatomical Landmark to Facilitate Occipital Artery Harvest: A Retrospective Clinical Study. World Neurosurg 2021; 157:e364-e373. [PMID: 34673238 DOI: 10.1016/j.wneu.2021.10.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypass is a challenging procedure and is not frequently performed owing to the difficulty of OA harvest. To facilitate harvest, the intersection between the sternocleidomastoid and splenius capitis (the OA triangle) is used as the anatomical landmark to identify the OA segment that carries the highest risk of damage. This clinical study aimed to demonstrate efficacy and safety of OA harvest using this landmark. METHODS The study included 18 patients who underwent OA harvest using the OA triangle as a landmark for treatment of vertebral artery and PICA aneurysms. Patients were retrospectively evaluated for safety and patency of OA after harvest and OA-PICA bypass. RESULTS Of 18 patients with ruptured and unruptured vertebral artery and PICA aneurysms, 13 (72.2%) underwent OA-PICA bypass and 5 (27.8%) did not undergo bypass. The OA was completely harvested without damage in all patients. After harvest, the OA was patent in 17 patients (94.4%) and was occluded in 1 patient owing to vasospasm; this patient then underwent recanalization resulting in good patency of the OA-PICA bypass. The patency rate of the OA-PICA bypass was 100%. CONCLUSIONS The OA triangle, which is the anatomical landmark of the proximal end of the transitional segment of the OA, facilitated OA harvest using the distal-to-proximal harvest technique with safety and good patency. To the best of our knowledge, this is the first study of OA harvest in clinical cases.
Collapse
Affiliation(s)
- Kitiporn Sriamornrattanakul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
| | - Nasaeng Akharathammachote
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| |
Collapse
|
6
|
Ortiz-Rafael J, Chakravarthi SS, Revuelta-Gutiérrez R, Kassam A, Monroy-Sosa A. Microsurgical anatomy of the cranial nerve-centric triangles of the posterior cranial base: cadaveric and radiological anatomical study. Anat Sci Int 2021; 96:531-543. [PMID: 34132987 DOI: 10.1007/s12565-021-00620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Tumors in the posterior fossa can be situated either dorsal and lateral, ventral and medial, or occupying both regions in relation to the cranial nerves, with the latter position being especially challenging. In an effort to organize neurovascular complexes contained within, anatomically based triangles have been proposed to serve as guiding landmarks for locating critical neurovascular structures. The objectives of this study were to: (1) provide a review of historical anatomically based vascular-centric triangles of the posterior fossa based on respective neurovascular complexes; (2) introduce a more organized alternative system of triangles with the conceptualization of a projection system from superficial to deep; and (3) propose and describe two new triangles of the posterior fossa: Petrous-Acousticofacial and Acousticofacial-Trigeminal. Five cadavers were studied. Neurovascular complexes were described with the use of anatomically guided cranial nerve-centric triangles, each of which was formed by cranial nerves, petrous bone, brainstem, tentorium, and superior petrosal vein. All triangles were measured and anatomical boundaries confirmed by neuronavigation. Two circumferential frameworks were created to correlate superficial and deep anatomy: (1) Outer circumference and (2) Inner circumference. Posterior fossa was divided into the following: (1) Superior complex-corresponds to the sub-asterional region, which was projected to the trigeminal nerve; (2) Middle complex-corresponds to the mastoid emissary vein foramen, which was projected to the facial and vestibulocochlear nerves; and (3) Inferior complex-corresponds to the posterior condylar canal, which projects to the lower cranial nerves. Neuronavigation confirmed these landmarks. Two new triangles were proposed: (1) The Petrous-Acousticofacial triangle, and (2) The Acousticofacial-Trigeminal triangle. Triangles provide a useful anatomical guide to the posterior fossa. We have introduced an organized schema, as well as proposed two new triangles, with the intent to minimize manipulation of neurovascular structures.
Collapse
Affiliation(s)
| | - Srikant S Chakravarthi
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, W Kinnikinic River Pkwy #680, 2801, Milwaukee, WI, 53215, USA
- Skull Base, and Cerebrovascular Lab Aurora Research Institute, Milwaukee, WI, USA
| | - Rogelio Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", México City, Mexico
| | | | - Alejandro Monroy-Sosa
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, W Kinnikinic River Pkwy #680, 2801, Milwaukee, WI, 53215, USA.
- Skull Base, and Cerebrovascular Lab Aurora Research Institute, Milwaukee, WI, USA.
- Department of Neurosurgery, Institute for Social Security and Services for State Workers Tláhuac, Mexico City, Mexico.
| |
Collapse
|
7
|
Hatano Y, Ota N, Noda K, Okada Y, Suzuki Y, Fukuyama S, Tanada S, Hashimoto A, Kondo T, Miyazaki T, Kinoshita Y, Kamiyama H, Tokuda S, Tanikawa R. Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction. Surg Neurol Int 2019; 10:127. [PMID: 31528463 PMCID: PMC6744747 DOI: 10.25259/sni-16-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings. Methods: From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG). Results: The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs. Conclusion: Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.
Collapse
Affiliation(s)
- Yuto Hatano
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yosuke Suzuki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Shusei Fukuyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Shuichi Tanada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Atsumu Hashimoto
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Tomomasa Kondo
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| |
Collapse
|
8
|
Sriamornrattanakul K, Akharatham Machote N, Wongsuriyanan S, Mongkolratnan A. Contralateral Transcondylar Fossa Approach with Bilateral V3 Segment Exposure for Clipping of Vertebral Artery Aneurysm Which Deviates Across Midline: A Case Report and Review Article. Asian J Neurosurg 2019; 14:930-934. [PMID: 31497132 PMCID: PMC6703026 DOI: 10.4103/ajns.ajns_90_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This article reports a patient with unruptured right vertebral artery aneurysm which deviates across the midline to the left side. The contralateral (left) transcondylar fossa approach with bilateral V3 exposure is used for aneurysm clipping. The literature related to this technique is also reviewed.
Collapse
Affiliation(s)
- Kitiporn Sriamornrattanakul
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nasaeng Akharatham Machote
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Somkiat Wongsuriyanan
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Atithep Mongkolratnan
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| |
Collapse
|
9
|
Liang L, Qu L, Chu X, Liu Q, Lin G, Wang F, Xu S. Meningeal Architecture of the Jugular Foramen: An Anatomic Study Using Plastinated Histologic Sections. World Neurosurg 2019; 127:e809-e817. [PMID: 30954756 DOI: 10.1016/j.wneu.2019.03.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This 3-dimensional histologic study aimed to provide a precise description of the meningeal structures in the jugular foramen. METHODS 22 posterior skull base tissue blocks containing the jugular foramen region were obtained from 11 human cadaveric heads. These blocks were plastinated and cut into serial sections. After staining, these sections were examined under an optical microscope and used to reconstruct a 3-dimensional visualization model. RESULTS At the intracranial orifice of the jugular foramen, the meningeal dura formed 2 separate dural perforations: the glossopharyngeal meatus and the vagal meatus. The arachnoid extended into 2 dural meatuses and terminated at the inferior ganglion of the glossopharyngeal nerve in the glossopharyngeal meatus and the superior ganglion of the vagus nerve in the vagal meatus. At the intraforaminal part of the jugular foramen, the meningeal dura encased the glossopharyngeal nerve to form a dural sheath while encasing the vagus and accessory nerves to form a dural network. At the extracranial orifice of the jugular foramen, the dural wall of the jugular bulb extended downward to form a dense connective tissue sheath. The initial end of the internal jugular vein invaginated into this sheath and fused with the jugular bulb. CONCLUSIONS Knowledge of the anatomy of the meningeal architecture of the jugular foramen can be helpful in avoiding surgical complications of the lower cranial nerves when this complex area is approached.
Collapse
Affiliation(s)
- Liang Liang
- Department of Anatomy, Anhui Medical University, Hefei, China; Chinese Brain Bank, Anhui Medical University, Hefei, China
| | - Lianghua Qu
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Xuan Chu
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Qiang Liu
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Guoxiong Lin
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Feng Wang
- Department of Anatomy, Anhui Medical University, Hefei, China; Chinese Brain Bank, Anhui Medical University, Hefei, China
| | - Shengchun Xu
- Department of Anatomy, Anhui Medical University, Hefei, China; Chinese Brain Bank, Anhui Medical University, Hefei, China.
| |
Collapse
|
10
|
Manjila S, Bazil T, Kay M, Udayasankar UK, Semaan M. Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications. Neurosurg Focus 2018; 45:E5. [DOI: 10.3171/2018.5.focus18106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sunil Manjila
- 1Department of Neurosurgery, McLaren Bay Region Medical Center, Bay City, Michigan
| | - Timothy Bazil
- 1Department of Neurosurgery, McLaren Bay Region Medical Center, Bay City, Michigan
| | - Matthew Kay
- 2Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and
| | - Unni K. Udayasankar
- 2Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and
| | - Maroun Semaan
- 3Department of ENT, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| |
Collapse
|
11
|
Hellstern V, Aguilar-Pérez M, Schob S, Bhogal P, AlMatter M, Kurucz P, Grimm A, Henkes H. Endovascular Treatment of Dural Arteriovenous Fistulas of the Anterior or Posterior Condylar Vein : A Cadaveric and Clinical Study and Literature Review. Clin Neuroradiol 2018; 29:341-349. [PMID: 29404621 PMCID: PMC6579778 DOI: 10.1007/s00062-018-0669-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/19/2018] [Indexed: 11/28/2022]
Abstract
Dural arteriovenous fistulas (DAVF) involving the anterior and posterior condylar vein at the skull base are rare but important to recognize. Due to the highly variable anatomy of the venous system of the skull base, detailed anatomical knowledge is essential for correct diagnosis and appropriate treatment of these lesions. In this report we review the normal anatomy of the condylar veins and describe rare and, to our knowledge, not previously reported anatomical variants. We also highlight the treatment modalities for these lesions with focus on the endovascular transvenous occlusion based on four consecutive cases from our center.
Collapse
Affiliation(s)
- V Hellstern
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.
| | - M Aguilar-Pérez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - S Schob
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - P Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - M AlMatter
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - P Kurucz
- Department of Neurosurgery, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - A Grimm
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary.,Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - H Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculity, University Duisburg-Essen, Essen, Germany
| |
Collapse
|