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Skull base tumors
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Angela Richardson, Cathy M. Rosenberg, Jacques Morcos
In contrast to these general symptoms, another subset of symptoms is specific to tumor location; if cranial nerve deficits are present, they can help localize the tumor. (Refer to Chapter 9 for a review of the cranial nerve exam.) Lesions of the anterior skull base such as olfactory groove meningiomas can present with anosmia, or lack of a sense of smell. Involvement in the orbit or along the optic nerves, chiasm, or tract can produce specific visual field defects depending on the location. Tumors of the orbital apex or cavernous sinus may result in diplopia due to compromise of the nerves controlling the extraocular movements (CN III, IV, VI). Involvement of the cavernous sinus is more likely if facial sensation is impaired. Facial sensation (CN V) can be altered by lesions interrupting any or all of the three branches (V1, V2, V3) of the trigeminal nerve. Lesions of the cerebellopontine angle (CPA) can alter facial sensation, abduction of the eye, hearing, vestibular function, and/or facial movement. More extensive lesions of this region, or lesions arising closer to the jugular foramen and hypoglossal canal, can cause significant difficulties swallowing or with vocal cord function or tongue movement due to compression of the lower cranial nerves (CN IX, X, XI, XII).
Cancer pain syndromes
Published in Nigel Sykes, Michael I Bennett, Chun-Su Yuan, Clinical Pain Management, 2008
Robert Twycross, Michael Bennett
Involvement of the hypoglossal nerve (XII) indicates involvement of the neighboring hypoglossal canal. An associated Horner’s syndrome indicates extracranial involvement of the sympathetic nerves in proximity to the jugular foramen: ipsilateral ptosis;constricted pupil;enophthalmos;reduced facial sweating.
Abnormal Skull
Published in Swati Goyal, Neuroradiology, 2020
The posterior cranial fossa (PCF) or skull base (PSB) is formed by the posterior part of the temporal bone and the occipital bone. Due to bone-induced beam-hardening artifacts on images, the evaluation of the PCF is often compromised. The foramen magnum, part of occipital bone, is the largest foramen of the skull, which transmits vertebral arteries, anterior/posterior spinal arteries, and the spinal accessory nerve.The jugular foramen, at the posterior end of the petro-occipital suture, is divided by a fibrous or bony septum into anteromedial pars nervosa and posterolateral pars vascularis. The right jugular foramen, being larger than the left in most of the population, is a normal variant, and occasionally both cranial nerves IX and X pass through the pars nervosa.The pars nervosa is smaller than the pars vascularis, and the glossopharyngeal nerve (IX), with its tympanic branch (Jacobson’s nerve), and the inferior petrosal sinus, are transmitted through it. The pars vascularis is larger and the internal jugular vein, the vagus nerve (X), with its auricular branch (Arnold’s nerve), the accessory nerve (XI), and the posterior meningeal artery, are transmitted through it.The hypoglossal canal transmits the hypoglossal nerve (cranial nerve XII).The internal acoustic meatus lies within the petrous part of the temporal bone (posteriorly). The facial nerve [VII], the vestibulocochlear nerve [VIII], and the labyrinthine artery traverse through it.
Bilateral Tapia’s syndrome secondary to cervical spine injury: a case report and literature review
Published in British Journal of Neurosurgery, 2023
Alexandros G. Brotis, Jiannis Hajiioannou, Christos Tzerefos, Christos Korais, Efthymios Dardiotis, Kostas N. Fountas, Kostantinos Paterakis
From the anatomical perspective, the efferent fibers of the X and XII CN emerge from the ambiguous and hypoglossal nerve nuclei of the medulla, respectively. The X CN leaves the medulla at the postolivary sulcus, while the rootlets of the XII CN exit at the preolivary sulcus, after travelling ventromedially within the reticular formation, lateral to the medial lemniscus and the pyramidal tract. They both traverse the basal cisterns (cerebello-medullary for the X and premedullary for the XII) lateral to the vertebral artery and penetrate the dura. The X and XII CN exit the skull from the jugular foramen (pars venosa) and hypoglossal canal, respectively. After giving off two branches, the meningeal and the auricular branch of Arnold, the X CN joins the IX, XI and XII CN and run together within the carotid sheath for several centimeters. At the level of the transverse process of the atlas, the XII to ramifies into muscular branches, while the X CN gives-off a few additional branches, including the recurrent laryngeal nerve (RLN) and the cardiac branches. Of notice, the right RLN arises in front of the subclavian artery and ascends into the right tracheoesophageal sulcus to supply the vocal cords and all the laryngeal muscles except the cricothyroid. The left RLN descends below the aortic arch.
Facial nerve paralysis in malignant otitis externa: comparison of the clinical and paraclinical findings
Published in Acta Oto-Laryngologica, 2020
Sasan Dabiri, Narges Karrabi, Nasrin Yazdani, Ahmad Rahimian, Azita Kheiltash, Mehrdad Hasibi, Elham Saedi
The first articles published on MOE mentioned manifestations of the disease including paralysis of the cranial nerves and more commonly the facial nerve palsy associated with a 50% increased risk of mortality. The cranial nerves are affected may be due to inflammation of the skull base or neurotoxins secreted by pathogen spp. The facial nerve has the most integration with the temporal bone, so it is usually the first and the most nerve that is affected. As the disease progresses, the ninth, tenth, and eleventh cerebral nerves at the site of the jugular and twelfth nerves in the hypoglossal canals are affected. If the disease spreads to the apex of the petrous, the fifth and sixth cranial nerves may also involve. Optic nerve involvement with MOE rarely might occur. Other cranial nerves are usually not involved [12].
Type 2 persistent primitive proatlantal intersegmental artery, a rare variant of persistent carotid-vertebrobasilar anastomoses
Published in Baylor University Medical Center Proceedings, 2019
Gagandeep Choudhary, Narendra Adhikari, Jad Chokr, Nishant Gupta
The ProA is an important blood supply to the posterior fossa structures until the seventh and eighth weeks before VA development. Persistent ProAs can be divided into two types based on their origin. Type 1 (∼57%) corresponds to the first segmental artery, arises from the ICA, and joins the V4 segment of VA, and type 2 (43%) corresponds to the second segmental artery, arises from the external carotid artery or rarely from the common carotid artery, and joins the V3 segment of VA.4,5 Irrespective of their origin, the vessels enter the skull through the foramen magnum. The hypoglossal and ProA are similar but can be differentiated by their course and skull entry site. The hypoglossal course can have a higher origin at the C1 vertebra or the C1 to C2 interspace, is vertically oriented, and enters the skull through the hypoglossal canal. In contrast, the ProA typically arises from the C2 or C3 vertebral level, has a suboccipital horizontal course similar to the V3 segment, and enters the skull through the foramen magnum.5 Proximal VAs are absent or hypoplastic in half of the individual with persistent ProA.6