The anatomy of the inferior petrosal sinus,glossopharyngeal nerve,vagus nerve,and accessory nerve in the jugular foramen.

PURPOSETo define the variations of the courses of the cranial nerves and the inferior petrosal sinuses as they enter and traverse the jugular foramen.METHODSThirty-nine cadaveric specimens containing the jugular foramen were scanned with 1-mm contiguous axial and coronal CT sections. Each specimen was dissected to evaluate the position of the cranial nerves and inferior petrosal sinus as they entered the jugular foramen.RESULTSThe glossopharyngeal nerve entered the most superior, anterior, and medial aspect of the jugular foramen and descended in the anterior portion of the jugular foramen, often within a groove. The vagus and accessory nerves could not be separated by CT. They entered the jugular foramen most often anterior or anterior and inferior to the jugular spine of the temporal bone and descended in a position ranging from medial to anterior to the jugular vein. The inferior petrosal sinus most often coursed inferior to the horizontal portion of the glossopharyngeal nerve and entered the jugular system in the jugular foramen, at the exocranial opening or below the skull base. A pars nervosa and pars venosa could be identified only at the endocranial opening, where the jugular spine separated the pars nervosa containing the inferior petrosal sinus and three cranial nerves from the pars venosa containing the jugular vein.CONCLUSIONOur evaluation demonstrated anatomic variation in the area of the jugular foramen.     

Accessory nerve neuroma presenting as recurrent jugular foramen syndrome

Summary We report a patient with spontaneous recovery and recurrence of a jugular foramen syndrome secondary to an accessory nerve neuroma. He showed sudden onset of unilateral palsy of the ninth, tenth and eleventh cranial nerves in 1982. He recovered almost fully and in 1990 the palsies recurred. MRI revealed a small mass in the right jugular foramen. The tumour was resected via suboccipital craniectomy, and diagnosed as a neuroma of the eleventh cranial nerve.     

Ceruminous tumor of the jugular foramen.

Intrapetrous ceruminomas are rate tumors; only four cases have been reported in the literature. These had characteristics of cerebellopontine angle tumors. Our case had the characteristics of a tumor of the jugular foramen.     

Neurinoma of the jugular foramen

Summary The complementary predications of modern imaging techniques, CT, MRI and intraarterial digital subtraction angiography (i.a. DSA), in the differential diagnosis of a neurinoma of the jugular foramen are described.     

Magnetic resonance imaging of the jugular foramen

The jugular foramen in normal volunteers was studied with 1.5 T magnetic resonance (MR) systems in 3-mm-thick head- and surface-coil images. Anatomic sections through cadaver heads were correlated with the MR images to identify the jugular bulb and the course of cranial nerves IX-XI. Sagittal images were more useful than coronal or axial to show the course of these nerves through the skull base. MR demonstrates the anatomic relations of the jugular foramen (except its osseous margins) such that its primary use in evaluating this region can be anticipated.     

Preoperative embolization of anastomoses of the jugular bulb: an adjuvant in jugular foramen surgery.

We describe the technique of preoperative embolization of the inferior petrosal sinus/anterior condylar vein complex and the posterior condylar vein in three patients undergoing skull base surgery that required opening of the jugular bulb. Contrary to the usual situation, essentially no blood was lost during the operation, resulting in decreased surgical time and reduced risk to the lower cranial nerves.     

Adenoid cystic carcinoma of jugular foramen

Adenoid cystic carcinoma is a slowly growing malignant tumor with high local recurrence, perineural and vascular invasion. This tumor might arise from the glands of upper respiratory tract and oral cavity (eg, salivary or serous or mucous). Here we report the case of a 65-year-old woman who was referred to our unit for left retro-auricular radiating pain with trigger points and frontal headache since 6 months. There was no involvement of cranial nerves. Imaging screening using MRI, Positron emission tomography with 2-[fluorine-18] fluoro-2-deoxy-D-glucose, Gallium-68 DOTA-Phe1-Tyr3-Octreotide (68Ga DOTATOC) Positron emission tomography-CT suggested a suspicion of schwannoma or paraganglioma of the jugular foramen. However, the CT-guided biopsy revealed presence of adenoid cystic carcinoma. These warrants performing mandatory histological analysis combined with imaging screening suspicion of schwannoma or paraganglioma.     

Imaging findings in schwannomas of the jugular foramen

BACKGROUND AND PURPOSE: Tumors of the cranial nerve sheath constitute 5% to 10% of all intracranial neoplasms, yet few articles have described their CT and MR characteristics. We report the imaging findings in a relatively large series of schwannomas of the jugular foramen, contrasting them with other disease entities, especially vestibular schwannomas and tumors of the glomus jugulare. METHODS: CT and/or MR studies of eight patients who underwent surgery for histologically proved schwannomas were reviewed retrospectively. One additional patient with an assumed schwannoma of the jugular foramen, who did not have surgery, was also included. RESULTS: Surgical findings showed schwannomas of the glossopharyngeal nerve in seven patients and tumor involvement of both the glossopharyngeal and vagal nerves in one patient. All tumors were partially located within the jugular foramen. Growth extending within the temporal bone was typical. Tumor extended into the posterior cranial fossa in all nine patients and produced mass effect on the brain stem and/or cerebellum in seven patients; in five patients, tumor extended below the skull base. On unenhanced CT scans, tumors were isodense with brain in six patients and hypodense in two. In seven patients, CT scans with bone algorithm showed an enlarged jugular foramen with sharply rounded bone borders and a sclerotic rim. On MR images, T1 signal from tumor was low and T2 signal was high relative to white matter in all patients. Contrast enhancement on CT and/or MR studies was strong in eight patients and moderate in one. CONCLUSION: Schwannoma of the jugular foramen is characteristically a sharply demarcated, contrast-enhancing tumor, typically centered on or based in an enlarged jugular foramen with sharply rounded bone borders and a sclerotic rim. Intraosseous extension may be marked.     

颈静脉孔区薄层影像解剖学研究

目的 以薄层断层解剖学研究为基础，研究颈静脉孔区结构的CT和MRI表现。方法 选取2个经10％甲醛溶液浸泡的成年头颅标本行CT和MR扫描后，以1mm层厚薄层切片。选取20例无颅底区和鼻咽部病变的CT平扫并增强的病例作为CT组正常研究对象，采用CT螺旋扫描，高质量(HQ)扫描模式。选择健康志愿者20例行MR扫描，扫描序列包括SET1WI、快速自旋回波(FSE)T2WI和三维傅立叶采集稳态梯度回波(3D radio—frequency fourier acquired steady—state，3D RF—FAST)。结果 颈静脉孔区分为颈静脉孔内口、孔腔和外口3个层面。在颈静脉孔入口，有分别包绕舌咽神经的舌咽道和包绕迷走神经、副神经的迷走道，CT可显示舌咽道和迷走道(20例，100%)，MRI可分别显示舌咽神经进入舌咽道，迷走副神经进入迷走道，其中3DRF—FAST序列为17例(85％)，SE T1WI序列为14例(70％)，FSE T2WI序列为10例(50%)。在颈静脉孔腔，舌咽神经、岩下窦、迷走神经、副神经和颈静脉球南前内向后外依次排列，CT检查难以分辨腔内结构，MR 3D RF—FAST序列中16例(80%)可显示。颈静脉孔的外口与舌下神经管相毗邻。CT显示外口形状。在与舌下神经管平行的MR斜矢状面上，可同时显示后组脑神经分别经颈静脉孔外口和舌下神经出、入颅。结论 CT、MRI的相互补充有利于颈静脉孔区结构的显示。     

Gradient recalled echo MR imaging of the jugular foramen

Axial T1-weighted spin-echo MR images have not proved to be effective in identifying normal structures in the jugular foramen. By correlating cryomicrotomic sections and axial T1-weighted gradient recalled echo images, we identified the neural and vascular contents of the jugular foramen. Further work with gradient recalled echo images is needed to determine the signal characteristics of jugular foraminal lesions.     

Simultaneous neurofibroma and schwannoma of the sciatic nerve.

The authors report a case of simultaneously occurring neurofibroma and schwannoma of the sciatic nerve and discuss the complementary aspects of MR and US. The schwannoma was well-defined and showed distal enhancement on sonographic evaluation, whereas the neurofibroma was ill-defined; both tumors were hypoechoic. T1- and T2-weighted MR images revealed similar signal characteristics of the two tumors, but intense enhancement following administration of gadolinium-DTPA distinguished the schwannoma from the neurofibroma.     

颈静脉孔区肿瘤的CT和MRI诊断

目的：探讨CT和MRI对颈静脉孔区肿瘤的诊断及鉴别诊断。方法：回顾性分析了经手术病理证实的34例颈静脉孔区肿瘤的CT和MR影像资料,其中包括颈静脉球瘤12例,神经鞘瘤10例,转移瘤3例,脑膜瘤2例,神经纤维瘤、脊索瘤、软骨瘤、软骨肉瘤、纤维脂肪瘤、纤维血管瘤和先天性囊肿各1例。CT检查21例,其中15例作增强扫描。MRI检查31例,其中24例加作MR增强扫描。结果：肿瘤内纡曲流空的血管即“椒-盐”征是颈静脉球瘤的特征性MRI表现。神经鞘瘤易发生囊变,注射对比剂后肿瘤中度强化。转移瘤骨质破坏不规则。脑膜瘤增强扫描可见脑膜“尾巴”征。软骨瘤和软骨肉瘤可见明显钙化。结论：CT与MRI相结合能更全面地为临床提供诊断、鉴别诊断及治疗所需要的信息,为治疗方法的选择提供可靠的依据。     

Malignant schwannoma of the trigeminal nerve

SUMMARY: We present the MR imaging, CT, and clinical findings of a patient with malignant schwannoma of the trigeminal nerve. Local tumor recurrence is frequent and may be mistaken for lymphatic spread. In this report, we emphasize the natural history of this rare tumor and discuss the importance of imaging in diagnosis and surveillance.     

颈静脉孔区肿瘤的CT和MR影像分析及诊断

颈静脉孔区肿瘤种类繁多,术前诊断困难.笔者总结23例经手术病理证实的颈静脉孔区肿瘤的CT及MRI表现,以提高埘颈静脉孔区肿瘤诊断准确率.一、资料与方法搜集本院经手术病理证实的23例颈静脉孔区肿瘤,其中神经鞘瘤8例,颈静脉-鼓室球瘤6例,脑膜瘤2例,软骨肉瘤3例,脊索瘤、颅咽管瘤、内淋巴囊乳头状腺瘤及转移瘤各1例.     

The accessory costotransverse foramen: a radioanatomical study

One hundred fifty-six anatomical specimens of cervical vertebrae and 55 C1 and 53 C2 vertebrae were examined for the presence of an accessory costotransverse foramen. We also reviewed 60 cervical spine computed tomographic (CT) scans. The variations of the costotransverse and accessory foramen are discussed. The frequency of the latter is 19% in the anatomical specimens and 45% in CT scans. The local anatomy and the excellent visualization on axial transverse CT are stressed.     

The normal jugular spur, jugular foramen, and jugular bulb as visualized on skull and temporal bone radiographs

Special jugular foramen views or tomography are generally used to radiographically delineate the jugular spur, jugular fossa, and jugular foramen. Details of this area are not ordinarily searched for by the radiologist on skull films nor otoroentgen views of the temporal bone for various reasons: attention to certain small "key-areas," rectilinear distortion, superimposition of neighboring structures, radiodensity of the petrous pyramid, etc. This paper outlines the radiographic anatomy of the jugular area and details its appearance on plain skull films (AP, PA, and submentovertical projections) and on special views of the temporal bone (Schuller's, Owen's, Mayer's, Stenvers', Low-Beer's).     

Primary jugular foramen meningioma: imaging appearance and differentiating features

OBJECTIVE: Primary jugular foramen meningiomas behave differently from meningiomas arising elsewhere. The differences have important clinical, imaging, and surgical implications. We reviewed the imaging appearances of primary jugular foramen meningiomas and evaluated them for features that might assist in differentiating them from other common jugular foramen lesions. MATERIALS AND METHODS: A retrospective review identified five cases of primary jugular foramen meningioma. We defined it as primary when it was centered in the jugular foramen and secondary when it was centered in the posterior fossa with secondary extension into the jugular foramen. Secondary jugular foramen meningiomas were excluded from this study. Eight cases of jugular foramen paraganglioma and 10 cases of jugular foramen schwannoma were reviewed for comparison. RESULTS: Primary meningioma was characterized by centrifugal infiltration surrounding the skull base (5/5), a permeative-sclerotic appearance to the bone margins of the jugular foramen (5/5), and prominent dural tails (5/5). Flow voids were absent in all cases. Paraganglioma showed localized skull base infiltration, with predominant superolateral spread into the middle ear cavity (8/8). Flow voids and permeative destruction of the bone margins of the jugular foramen were typical. Schwannoma caused expansion of the jugular foramen with scalloped well-corticate bone margins, without skull base infiltration. CONCLUSION: Primary jugular foramen meningioma is characterized by extensive skull base infiltration. A centrifugal pattern of spread, a permeative-sclerotic appearance of the bone margins of the jugular foramen, the presence of dural tails, and an absence of flow voids are particularly important features that assist in differentiating primary jugular foramen meningioma other more common jugular foramen lesions.