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At least 145 records · Page 8Linked to original sources

PubMed2000

Conservative facial nerve management in jugular foramen schwannomas.

OBJECTIVE: Although transposition of the facial nerve is crucial in infiltrative vascular lesions involving the jugular foramen, the objective was to show that a conservative approach to management of the facial nerve is sufficient with jugular foramen neuromas because of their noninfiltrative, less vascular nature and medial location in the jugular foramen. STUDY DESIGN: Retrospective case review. SETTING: Tertiary, private, multiphysician, otologic practice. PATIENTS: Sixteen patients with jugular foramen schwannoma (18 procedures) treated between January 1975 and October 1995. The 8 male and 8 female patients ranged in age from 13 to 66 years (mean age 47.7 years). INTERVENTION: One-stage, total jugular foramen neuroma removal without transposition of the facial nerve, using a variety of surgical approaches. MAIN OUTCOME MEASURES: Facial nerve transposition (yes or no), House-Brackmann facial nerve grade, lower cranial nerve status, complications. RESULTS: One-stage total tumor removal was accomplished in all the cases. In 13 (72%) of the neuromas, removal was accomplished without facial nerve transposition. Transposition was performed in 2 revision cases in which scar tissue from a previous operation prevented complete control of the carotid artery and safe removal, 2 cases with large tumor extension anteriorly to the petrous apex, and 1 case with extensive involvement of the middle ear. A House-Brackmann facial nerve Grade I or II was obtained in 16 of the 18 procedures, with 1 Grade III and 1 case that remained Grade V, as it was preoperatively. CONCLUSIONS: One-stage, total tumor removal can be achieved with excellent control of the important vascular structures and without transposition of the facial nerve in a majority of jugular foramen schwannomas.

Adolescent↗

PubMed1987

Valve-incompetent foramen ovale in premature infants with ductus arteriosus: a Doppler echocardiographic study.

In a 1 year period, 56 neonates with a clinical diagnosis of ductus arteriosus had Doppler echocardiographic confirmation of the ductus; 33 (59%) had additional, turbulent left to right flow at the atrial level through a valve-incompetent foramen ovale. Normalized left atrial dimensions in the group with the atrial shunt were significantly larger than when there was a competent foramen ovale; when the ductus closed and left atrial enlargement receded, the atrial shunt disappeared. However, several infants with large left chambers had no interatrial shunting. When the atrial shunt was present, there were up to three flow pulses, corresponding to atrial systole, ventricular systole and ventricular diastole, but these were frequently fused into two pulses or even one pulse per cycle. The atrial septal morphology provided supporting clues: general bowing of the septum or a localized bulge in the region of the foramen ovale indicated relatively high left atrial pressure, and frequently a slitlike dropout could be seen at the superior edge of the foramen. During the study, three additional neonates with a ductus arteriosus were found to have a secundum atrial septal defect with a typical echographic image, "matchhead" appearance of the septal rim of the defect, but the Doppler flow patterns were indistinguishable from those of a valve-incompetent foramen ovale. The hemodynamic effects of the interatrial shunt, from either cause, seemed slight during the hospital course, but the presence of a valve-incompetent foramen ovale indicated a relatively large ductal shunt. Quantification of the ductal shunt, however, continues to rely primarily on measurement of the left atrial and ventricular size.

Ductus Arteriosus, Patent↗

PubMedDate not supplied

Biplane transesophageal echocardiography in the diagnosis of patent foramen ovale.

Patent foramen ovale is associated with unexplained systemic embolic events or persistent hypoxemia. The diagnosis of a patient foramen ovale is based on the existence of an interatrial right-to-left shunt. Biplane transesophageal echocardiography with its increased ability to provide accurate anatomic detail may allow the visualization of the actual opening of the patent foramen ovale. In 19 patients with transesophageal positive contrast studies, we assessed the value of the vertical versus the horizontal plane in the diagnosis of a patent foramen ovale. The patent foramen ovale opening could be seen and sized in the vertical plane in 10 studies (53%). In none of these 10 cases was the opening seen also in the horizontal plane. We conclude that in a significant number of cases, biplane transesophageal echocardiography adds morphological detail to the diagnosis of patent foramen ovale. The ability to size the actual opening may have therapeutic implications.

Contrast Media↗

PubMed1998

Position of the mental foramen in a North American, white population.

UNLABELLED: Knowledge of the position of the mental foramen is important both when administering regional anesthesia and performing periapical surgery in the mandible. Although it is often possible to identify the mental foramen by palpation and radiographically, knowing the normal range of possible locations is essential. Standard anatomic texts have data collected from dried skulls, but often of unknown origin or from an ethnic group that does not represent the North American population. OBJECTIVES: This study identified the position of the mental foramen in a more representative sample of the North American population. Ethnic and gender differences were also investigated and the symmetry of location within individuals analyzed. STUDY DESIGN: Regional dissections of 105 human cadavers were carried out to identify the normal range of position of the mental foramen. The vertical and horizontal position was recorded with the two adjacent teeth used as references. If the two adjacent teeth were not present the foramen was not included in the study. RESULTS: The results indicated that the mental foramen was, on average, between the premolars, therefore not statistically different from previous studies. However, there appears to be a greater range than generally reported, which is of considerable clinical significance. Examples of dissections of unusually positioned mental foramina are given.

Anesthesia, Dental↗

PubMed1997

CT assessment of jugular foramen dominance and its association with hand preference.

Three hundred and seven normal CT scans of the head were prospectively analysed to assess jugular foramen dominance. After assessment, hand preference was elicited. Of these, 276 were right-handed and 31 were left-handed. Of the right-handed patients: 180 had a larger jugular foramen on the right; 63 had a larger jugular foramen on the left; and in 33 no difference could be discerned. Of the left-handed patients: 11 had a larger jugular foramen on the right; 16 had a larger jugular foramen on the left; and in four no difference could be discerned. The results suggested a significant association between jugular foramen dominance and hand preference.

Chi-Square Distribution↗

PubMed2000

The value of the size of foramen magnum in sex determination.

Sex determination in unidentified skeletons is not always easily and correctly performed by a non-specialist without formal training in forensic anthropology. In explosions, warfare and other mass disasters like aircraft crashes, identification may be extremely complicated because of skeletal fragmentation. The aim of the present study was to determine whether the area of the foramen magnum was a useful criterion for the sex determination in fragmented skulls. In a total of 219 skeletons (170 males and 39 females) the longest and the shortest diameter of the foramen magnum was measured; the area within was determined using the mean of the diameters as the radius for calculation. The mean of foramen magnum area was significantly different (909.91 +/- 126.02 mm2 in males, 819.01 +/- 117.24 mm2 in females homogeneous variance, Student's t-test: 4.11 P< 0.001). However, the correlation coefficient between the areas of foramen magnum and sex was 0.27. The results confirmed that the mean foramen magnum area in females is lower than in males. However, the area of foramen magnum is not a very useful indicator for sex identification and can be used only under some circumstances as a supportive finding.

Journal Article↗

PubMed2001

Comprehensive microsurgical anatomy of the jugular foramen and review of terminology.

The microsurgical anatomy of the jugular foramen was studied in 12 formalin preserved cadavers (24 foramina) and 40 dry-skulls (80 foramina). The jugular foramen was exposed by microsurgical dissection with drilling from a superior to inferior direction. Observations regarding dural architecture of the jugular foramen and relationships between neurovascular structures passing through the foramen were noted in cadavers. Normal bony construction of the foramen and its variational anatomy were examined in dry-skull specimens. Using photographs and drawings, the anatomy of the jugular foramen is presented and related terminology is discussed in the light of a literature review.

Cadaver↗

PubMed2005

Endoscope assisted removal of jugular foramen schwannoma; report of 3 cases.

Removal of the intraforaminal portion of a jugular foramen schwannoma under direct vision requires resection of the adjacent bone. Extensive resection of the bone around the jugular foramen, however, involves a potential danger for cerebrospinal fluid (CSF) leakage and for damage to the adjacent cranial nerves as well as venous outflow. To avoid such bone resection, we applied the endoscope during the removal of a jugular foramen schwannoma through the lateral suboccipital approach. Three patients with schwannomas in the jugular foramen were treated using the lateral suboccipital approach with endoscopic assistance. After the intracranial portion was first removed under the microscope, the residual tumor in the jugular foramen was subsequently removed under the side-viewing endoscope. In all cases the tumor was removed successfully without major complications. The authors conclude that if the cases are selected properly, removal of the schwannoma extending into the jugular foramen is feasible through the conventional lateral suboccipital window under endoscopic assistance.

Adult↗

PubMed1998

Microsurgical anatomy for lateral approaches to the foramen magnum with special reference to transcondylar fossa (supracondylar transjugular tubercle) approach.

Microsurgical anatomy for lateral approaches to the foramen magnum, especially for transcondylar fossa (supracondylar transjugular tubercle) approach, was studied using cadavers. The transcondylar fossa approach is an approach in which extradural removal of the posterior portion of the jugular tubercle through the condylar fossa is added to the far lateral approach. Some differences between this approach and the transcondylar approach are demonstrated. The atlanto-occipital joint and the jugular tubercle are obstacles for the lateral approaches. The condylar fossa forming the external occipital surface of the jugular tubercle is located supero-posterior to the occipital condyle. The fossa is limited laterally by the sigmoid sulcus and the jugular foramen. The posterior condylar canal communicating anteriorly with the distal end of the sigmoid sulcus, the jugular foramen, or the hypoglossal canal opens at the bottom of the fossa. The condyle is situated inferior to the posterior condylar and hypoglossal canals, and the jugular tubercle is located superior to them. In the transcondylar fossa approach the posterior part of the jugular tubercle is extradurally removed, but the condyle and the atlanto-occipital joint are untouched. On the other band, in the transcondylar approach the medial parts of the condyle and the lateral mass of Cl are removed. The latter approach offers better visualization of the inferior part of the foramen magnum. The essential difference of the two approaches is in the direction of looking and the extent of resection of the atlanto-occipital joint. Both approaches offer excellent view of the ventral dural space in the lower clivus and the foramen magnum, but the level of exposure differs somewhat between them. In the lateral approaches to the foramen magnum, the condylar fossa, the posterior condylar canal, and the posterior condylar emissary vein all play an important role as intraoperative anatomical landmarks.

Journal Article↗

PubMed2001

Jugular foramen: microscopic anatomic features and implications for neural preservation with reference to glomus tumors involving the temporal bone.

OBJECTIVE: Our goals were to study the normal histological features of the jugular foramen, compare them with the histopathological features of glomus tumors involving the temporal bone, and thus provide insight into the surgical management of these tumors with respect to cranial nerve function. METHODS: Ten jugular foramen blocks were obtained from five human cadavers after removal of the brain. Microscopic studies of these blocks were performed, with particular attention to fibrous or bony compartmentalization of the jugular foramen, the relationships of the caudal cranial nerves to the jugular bulb/jugular vein and internal carotid artery, and the fascicular structures of the nerves. In addition, we studied the histopathological features of 11 glomus tumors involving the temporal bone (10 patients), with respect to nerve invasion, associated fibrosis, and carotid artery adventitial invasion. RESULTS: A dural septum separating the IXth cranial nerve from the fascicles of Cranial Nerves X and XI, at the intracranial opening, was noted. Only two specimens, however, had a septum (one bony and one fibrous) producing internal compartmentalization of the jugular foramen. The cranial nerves remained fasciculated within the foramen, with the vagus nerve containing multiple fascicles and the glossopharyngeal and accessory nerves containing one and two fascicles, respectively. All of these nerve fascicles lay medial to the superior jugular bulb, with the IXth cranial nerve located anteriorly and the XIth cranial nerve posteriorly. All nerve fascicles had separate connective tissue sheaths. A dense connective tissue sheath was always present between the IXth cranial nerve and the internal carotid artery, at the level of the carotid canal. The inferior petrosal sinus was present between the IXth and Xth cranial nerves, as single or multiple venous channels. The glomus tumors infiltrated between the cranial nerve fascicles and inside the perineurium. They also produced reactive fibrosis. In one patient, in whom the internal carotid artery was also excised, the tumor invaded the adventitia. CONCLUSION: Within the jugular foramen, the cranial nerves lie anteromedial to the jugular bulb and maintain a multifascicular histoarchitecture (particularly the Xth cranial nerve). Glomus tumors of the temporal bone can invade the cranial nerve fascicles, and infiltration of these nerves can occur despite normal function. In these situations, total resection may not be possible without sacrifice of these nerves.

Adult↗

PubMed2001

Morphologic changes in the lumbar intervertebral foramen due to flexion-extension, lateral bending, and axial rotation: an in vitro anatomic and biomechanical study.

STUDY DESIGN: A biomechanical and anatomic study with human cadaveric lumbar spine. OBJECTIVES: The purpose of this study is to examine the morphologic changes in the intervertebral foramen during flexion, extension, lateral bending, and axial rotation of the lumbar spine and to correlate these changes with the flexibility of the spinal motion segments. SUMMARY OF BACKGROUND DATA: Previous studies showed morphologic changes in the intervertebral foramen during flexion and extension; however, those changes during lateral bending and axial rotation were not well known. METHODS: There were 81 motion segments obtained from 39 human cadaveric lumbar spines (mean age 69 years). The motion segments were imaged with CT scanner with 1-mm thick consecutive sections. For biomechanical testing each motion segment was applied with incremental pure moments of flexion, extension, lateral bending, and axial rotation. Rotational movements of the motion segment were measured using VICON cameras. After application of the last load, the specimens were frozen under load, and then CT was performed with the same technique described above. Six parameters of the intervertebral foramen were measured, including foraminal width (maximum and minimum), foraminal height, disc bulging, thickness of ligamentum flavum, and cross-sectional area of the foramen. RESULTS: Flexion increased the foraminal width (maximum and minimum), height, and area significantly while significantly decreasing the disc bulging and thickness of ligamentum flavum (P < 0.05). However, extension decreased the foraminal width (maximum and minimum), height, and area significantly. Lateral bending significantly decreased the foraminal width (maximum and minimum), height, and area at the bending side, whereas lateral bending significantly increased the foraminal width (minimum), height, and area at the opposite side of bending. Likewise, axial rotation decreased the foraminal width (minimum) and area at the rotation side significantly while significantly increasing the foraminal height and foraminal area at the opposite side. The percent change in the foraminal area was found significantly correlated with the amount of segmental spinal motion except for the extension motion. CONCLUSIONS: This study showed that the intervertebral foramen of the lumbar spine changed significantly not only on flexion-extension but also on lateral bending and axial rotation. The percent change in cross-sectional foraminal area was correlated with the amount of segmental motion except for extension motions. Further studies are needed to assess the morphologic changes in the intervertebral foramen in vivo and to correlate clinically.

Adult↗

PubMed2006

Position of the mental foramen in a Korean population: a clinical and radiographic study.

PURPOSE: The purpose of this study was to improve the treatment methods for the mental foramen by comparing the directly measured values with the radiographic measured values. MATERIALS AND METHODS: One hundred and twelve mental foramina (72 males, 40 females) that were exposed during the operation were examined. The patients' age ranged from 12 to 69 years, with a mean age of 41.8 years. All patients had fully erupted lower premolars. The horizontal and vertical locations were evaluated with both direct and radiographic measurements. RESULTS: In 72 patients (64.3%), the mental foramen was below the second premolar. In 26.8%, it was between the first and second premolar, and in 8.9%, it was below the first premolar. By radiographic readings,most of the mental foramina were found to be below the second premolar (62.5%). The average distance between the cusp tip and the superior border of the mental foramen by direct measurement was 23.42 mm and 25.69 mm in the panoramic view. The mean distance between the superior border of the mental foramen and the bottom of the mandible was 14.33 mm by direct measurement and 16.52 mm by radiographic measurements. CONCLUSION: It is important to know the position of the mental foramen for the placement of osseointegrated implants in the mandibular premolar region. The position of the mental foramen of Koreans is closer to the cusp tips of lower premolars than Westerners.

Adolescent↗

PubMed1997

Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale.

OBJECTIVE: To investigate the role of a patient foramen ovale in the pathogenesis of multiple brain lesions acquired by sport divers in the absence of reported decompression symptoms. DESIGN: Prospective double blind cohort study. SETTING: Diving clubs around Heidelberg and departments of neuroradiology and neurology. SUBJECTS: 87 sport divers with a minimum of 160 scuba dives (dives with self contained underwater breathing apparatus). MAIN OUTCOME MEASURES: Presence of multiple brain lesions visualised by cranial magnetic resonance imaging and presence and size of patent foramen ovale as documented by echocontrast transcranial Doppler ultrasonography. RESULTS: 25 subjects were found to have a right-to-left shunt, 13 with a patent foramen ovale of high haemodynamic relevance. A total of 41 brain lesions were detected in 11 divers. There were seven brain lesions in seven divers without a right-to-left shunt and 34 lesions in four divers with a right-to-left shunt. Multiple brain lesions occurred exclusively in three divers with a large patent foramen ovale (P = 0.004). CONCLUSIONS: Multiple brain lesions in sport divers were associated with presence of a large patent foramen ovale. This association suggests paradoxical gas embolism as the pathological mechanism. A patent foramen ovale of high haemodynamic relevance seems to be an important risk factor for developing multiple brain lesions in sport divers.

Brain Injuries↗

PubMed1993

Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography.

BACKGROUND AND PURPOSE: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and, in some reports, with mitral valve prolapse. These two latter cardiac disorders have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. METHODS: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients < 55 years of age with ischemic stroke who underwent extensive etiological investigations. We compared these results with those in a control group of 50 consecutive patients. The diagnosis of atrial septal aneurysm and patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. RESULTS: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P = .01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P = .003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of > 10-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of < 10 mm. CONCLUSIONS: This study shows that atrial septal aneurysm and patent foramen ovale are both significantly associated with cryptogenic stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of > 10-mm excursion are associated with a higher risk of stroke.

Adolescent↗

PubMed2004

Mobility of the Septum primum does not depend on the foramen ovale diameter in normal fetuses.

OBJECTIVE: To test the hypothesis that a correlation exists between the maximum foramen ovale diastolic diameter and the excursion index (EI) of the septum primum in normal fetuses. METHODS: One hundred and two normal fetuses with gestational ages ranging from 20 to 40 weeks were submitted to echocardiography. The foramen ovale diameter and the "maximal excursion" of the septum primum were measured in a 4-chamber view. The data were analyzed by Pearson's correlation coefficient. RESULTS: The mean foramen ovale (FO) diameter was 5.06 +/- 1.29 mm; the maximal excursion of the septum primum was 5.42 +/- 1.41 mm; the left atrium diameter 11.47 +/- 2.76 mm; the septum primum "excursion index" was 0.48 +/- 0.09. Mean FO/EI ratio was 11.35 +/- 3.94 mm. No FO/EI correlation (r = -0.03) existed, and a weak foramen ovale/left atrium correlation (r = 0.31) was observed, as well as a weak foramen ovale/excursion of septum primum correlation (r = 0.21). CONCLUSION: Septum primum mobility does not depend on the foramen ovale diameter in normal fetuses, suggesting that the modifications of its diastolic displacement is not influenced by the size of the interatrial opening.

Adult↗

PubMed2004

Panoramic radiographic findings of the mandibular foramen from deciduous to early permanent dentition.

The purpose of this study was to investigate the position of the mandibular foramen from deciduous (Hellman's stage IIA) to early permanent dentition (Hellman's stage IVA). Panoramic radiographs of 311 Taiwanese children were used. The results revealed that the distances between the mandibular foramen and ramus anterior plane were greater than those between the mandibular foramen and ramus posterior plane through all stages. The mean difference between them was the smallest (0.25 mm) in stage IIA and the greatest (1.18 mm) in stage IIIC. The distance from the mandibular foramen to the alveolar crest plane showed a little change from stage IIA (3.99 mm) to IVA (5.26 mm). The gonial angle had a negative correlation with the distances between the mandibular foramen and each mandibular border. Evaluation of the mandibular foramen from the oral aspect can be influenced by the degree of mouth opening.

Adolescent↗

PubMed2003

The location of the mental foramen in a selected Malay population.

Knowledge of the position of the mental foramen is important both when administering regional anesthesia and performing periapical surgery in the mental region of the mandible. This study determines the position of the mental foramen in a selected Malay population. One hundred and sixty nine panoramic radiographs of Malay patients retrieved from a minor oral surgery waiting list were selected to identify the normal range for the position of the mental foramen. The foramen was not included in the study if there was any mandibular tooth missing between the lower left and right first molars (36-46). The findings indicated the most common position for the mental foramen was in line with the longitudinal axis of the second premolar (69.2%) followed by a location between the first and second premolar (19.6%). The right and left foramina were bilaterally symmetrical in three of six recorded positions in 67.7% patients. The mental foramen was most often in line with the second premolar.

Adolescent↗

PubMed2004

Jugular foramen tumors: diagnosis and treatment.

OBJECT: Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes. METHODS: The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004. All patients underwent surgery with a multidisciplinary method combining neurosurgical and ear, nose, and throat techniques. Preoperative embolization was performed for paragangliomas and other highly vascularized lesions. To avoid postoperative cerebrospinal fluid (CSF) leakage and to improve cosmetic results, the surgical defect was reconstructed with specially developed vascularized flaps (temporalis fascia, cervical fascia, sternocleidomastoid muscle, and temporalis muscle). A saphenous graft bypass was used in two patients with tumor infiltrating the internal carotid artery (ICA). Facial nerve reconstruction was performed with grafts of the great auricular nerve or with 12th/seventh cranial nerve anastomosis. Residual malignant and invasive tumors were irradiated after partial removal. The most common tumor was paraganglioma (58 cases), followed by schwannomas (17 cases) and meningiomas (10 cases). Complete excision was possible in 45 patients (77.5%) with paragangliomas and in all patients with schwannomas. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 10 patients (10%), but it was transient in four cases. Postoperative facial and cochlear nerve paralysis occurred in eight patients (8%); spontaneous recovery occurred in three of them. In the remaining five patients the facial nerve was reconstructed using great auricular nerve grafts (three cases), sural nerve graft (one case), and hypoglossal/facial nerve anastomosis (one case). Four patients (4%) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation. CONCLUSIONS: Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.

Adult↗