Jugular Foramen Lesions and their Management
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
The transverse sinus is an important structure in the venous drainage system of the brain, which opens into the sigmoid sinus. Venous flow proceeds via the jugular foramen through the skull base towards the IJV in the neck. Several venous pathways drain into the sigmoid–jugular complex: the superior and inferior petrosal sinuses, the occipital sinus and the mastoid and condylar emissary veins. The most important is the inferior petrosal sinus that contains the effluence of the cavernous sinus and the basilar plexus. The dome of the jugular bulb is in close contact with the floor of the hypotympanum, the vestibule, the posterior semicircular canal, the vestibular aqueduct and the internal auditory canal. The lateral side of the jugular bulb is close to the mastoid (vertical) segment of the facial nerve. The jugular foramen lies in close proximity to the internal carotid artery: only a small osseous spine separates the vertical part of the carotid canal from the jugular foramen (Figures 107.2 and 107.3).
Head, neck and vertebral column
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
Venous sinuses - veins within the skull formed by a double layer of dura mater normally located where dural folds meet the bones of the skull (Figs.3.1, 3.3, 3.4). The superior sagittal sinus (in the superior edge of the falx cerebri) runs posteriorly below the midline of the cranial vault to the confluence of sinuses. Most of the blood normally flows to the right, becoming the right transverse sinus, which in turn runs down as the right sigmoid sinus to pass through the jugular foramen on the right and emerging inferior to the skull as the right internal jugular vein. The straight sinus receives the inferior sagittal sinus (lying in the lower edge of the falx cerebri) and the great cerebral vein and runs posteriorly to the confluence of sinuses at the junction of the falx cerebri and tentorium cerebelli. Most of this blood normally flows to the left as the left transverse sinus, which continues as the left sigmoid sinus and, via the left jugular foramen, becomes the left internal jugular vein. The paired cavernous sinuses lie on either side of the pituitary gland and body of the sphenoid bone.
Practice Paper 5: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Cerebral venous sinus thrombosis describes a clot in one of the dural venous sinuses of the brain. The clinical features can depend on the underlying location of the thrombosis. Presentation is generally with a sudden-onset headache, seizures and signs of raised intracranial pressure, e.g. papilloedema, hypertension and bradycardia. More specific symptoms may be seen with cavernous sinus thrombosis (proptosis, ptosis, ophthalmoplegia, reduced sensation in the first division of the trigeminal nerve) and transverse sinus thrombosis (hemiparesis). Risk factors for the development of venous thromboses include contraceptive pill use, pregnancy, nephrotic syndrome and thrombophilias (protein S or C deficiency and antithrombin III deficiency). The diagnosis is confirmed by demonstrating the clot on CT or MRI. In sagittal sinus thrombosis, the ‘empty delta sign’ may be seen (a triangular area of enhancement within the sagittal sinus with a relatively low-attenuating centre). Management is with anticoagulation.
Microsurgical techniques for achieving gross total resection of ependymomas of the fourth ventricle
Published in Acta Chirurgica Belgica, 2020
Michael G. Z. Ghali
The telovelar [40–42,44,49,52] and transvermian [49] approaches readily gain resplendent neurosurgical access to the fourth ventricular cavity. The patient may alternatively be placed in the prone, sitting, or Concorde positions. Ventroflexion of the head facilitates operative exposure and working angles. Midline skin incision of the occiput and cervical region from the level of the inion to the level of the C2 spinous process exposes deeper tissues, allowing midline splitting of the fascia and dissection of the posterior cervical musculature down to the suboccipital bone and posterior surfaces of the upper cervical vertebrae [51]. The transverse sinuses and the posterior margin of the foramen magnum represent the rostral and caudal borders of the suboccipital trephination, respectively. Inclusion of a C1 laminectomy improves the bony exposure and may safely be performed up to the sulcus arteriosus in order to protect the vertebral artery. C1 laminectomy signifcantly enhances operative access and working angles to the rostral reaches and cerebral aqueduct of the fourth ventricle. C1 laminectomy renders rostral ventricular access gained by the transtelovelar approach equivalent to that gained by the vermian splitting transvermian approach [49]. This proves especially useful when utilizing the transtelovelar trajectory, though gains little other than surgeon comfort when achieving access to the fourth ventricular cavity via a vermian splitting approach.
Occipital petalia as a predictive imaging sign for transverse sinus dominance
Published in Neurological Research, 2019
Ezgi Yetim Arsava, Ethem Murat Arsava, Kader Karlı Oguz, Mehmet Akif Topcuoglu
All subjects had MRI on a 1.5-T scanner (Magnetom TIM, Symphony, Siemens, Erlangen, Germany). Axial three-dimension T1-weighted magnetization-prepared gradient recalled echo (MPRAGE) images (TR = 2600 ms; TE = 3.02 ms; FA = 8 degrees; FOV = 256 × 224 mm2) with 1 mm isotropic voxels, and 50% interslice distance were obtained. Morphological features including the presence and direction of occipital bending and side of transverse sinus dominance were studied. Occipital bending was determined by the methodology described by Maller et al. [8] According to this method, an anterior-posterior line through anterior falx and septum pellucidum was drawn manually to the posterior edge via posterior commissure at the lowest axial sequence including frontal horns and trigon. The angle between this line and another line crossing through the interhemispheric fissure between occipital lobes was used to identify occipital bending [8,14]. Visual assessment of the size of transverse sinuses themselves and dimensions of sigmoid notch on both sides guided the determination of the side of dominant venous drainage; these assessments were then also verified on axial T2-weighted images. Occipital bending and transverse sinus dominance assessments were made in a blinded fashion to each other by an experienced neuroradiologist.
Optic nerve sheath fenestration in patients with visual failure associated with vestibular schwannoma
Published in British Journal of Neurosurgery, 2019
Joanna M. Jefferis, Naz Raoof, Thomas Carroll, Sachin M. Salvi
We have described a series of three cases where we used ONSF as part of the management for visual failure in patients with VS in the absence of obstructive hydrocephalus. The three cases demonstrate three differing scenarios where ONSF may be considered in patients with VS. In the first case, papilloedema and significant poor vision were present at diagnosis of VS and worsened in spite of dexamethasone, acetazolamide, insertion of an EVD, and surgical excision of the VS. ONSF surgery was carried out after tumour resection and helped to resolve the papilloedema, improve her central vision and some of her peripheral vision. Our experience from this case showed that there is a potential delay following CSF diversion surgery and tumour resection before the optic nerve is safe from the effects of raised CSF pressure. This then coloured the management of the second case in which the patient had papilloedema and visual symptoms (transient visual obscurations) associated with the VS. ONSF surgery was carried out as the first line surgical management within four weeks from onset of symptoms. This allowed subsequent elective surgical removal of the VS whilst the patient maintained excellent vision. The third patient developed a transverse sinus thrombosis as a complication of skull base surgery for his VS. This in turn caused visual symptoms and papilloedema. ONSF was used in part of the management of this recognised complication of skull-based surgery.
Related Knowledge Centers
- Confluence of Sinuses
- Internal Jugular Vein
- Internal Occipital Protuberance
- Occipital Bone
- Petrous Part of The Temporal Bone
- Sigmoid Sinus
- Straight Sinus
- Superior Sagittal Sinus
- Temporal Bone
- Groove For Transverse Sinus
- Confluence of Sinuses
- Petrous Part of The Temporal Bone