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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(02): e174-e179
DOI: 10.1055/s-0041-1739166
Review Article

Historical Aspects and Surgical Nuances on the Craniocervical Approach to the Jugular Foramen

Aspectos históricos e dicas do acesso craniocervical ao forame jugular
Felipe Constanzo 
1   Department of Skull Base Surgery, Clinica Bio Bio, Concepción, Chile
2   Department of Neurological Surgery, Hospital Clinico Regional de Concepción, Concepción, Chile
,
Gustavo Fabiano Nogueira
3   Department of Otolaryngology, Instituto de Nuerologia de Curitiba, Curitiba, PR, Brazil
,
Mauricio Coelho Neto
4   Department of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
,
Ricardo Ramina 
4   Department of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
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Abstract

Context Tumors of the jugular foramen present a challenge to skull base surgeons. Their rarity, coupled with the complex anatomy of the region require exquisite knowledge and surgical technique. We present the history of the craniocervical approach to the jugular foramen, as well as surgical advice on how to manage the different extensions these tumors may present. The surgical nuances come from the experience of our skull base team managing over 150 tumors of the jugular foramen over the past 30 years. The history of the craniocervical approach was obtained by reviewing articles on surgery of the jugular foramen published on PUBMED over the past 100 years.

History The first craniocervical approach may be attributed to Gardner et al. in 1891, with posterior contributions from Shapiro and Neues, Gejrot, Kempe et al, Hilding and Greenberg, and Glasscock.

Nuances Cervical dissection with identification of the jugular vein, carotid bifurcation, and IX to XII cranial nerves was performed. Mastoidectomy with exposition of the fallopian canal, labyrinth, middle ear, sigmoid sinus, followed by a trans-sigmoid craniotomy with transposition of the vertebral artery gave access to the temporal and intracranial region.

Conclusion Approaching the jugular foramen is the epitome of skull base surgery. Several modifications of the standard approach may be necessary depending on the extension of the tumor.

Resumo

Contexto Os tumores do forame jugular apresentam um desafio para os cirurgiões da base do crânio. A sua raridade e a anatomia complexa da região requerem conhecimento específico da técnica cirúrgica. O presente manuscrito apresenta a história do acesso crâniocervical ao forame jugular, assim como dicas cirúrgicas para manejar as diferentes extensões que os tumores podem apresentar. As dicas são derivadas da experiência da nossa equipe em mais de 150 tumores do forame jugular nos últimos 30 anos. A história do acesso crâniocervical foi obtida da revisão de artigos em PUBMED dos últimos 100 anos.

História A primeira abordagem craniocervical pode ser atribuída a Gardner et al. em 1891, com contribuições posteriores de Shapiro e Neues, Gejrot, Kempe et al, Hilding e Greenberg e Glasscock.

Descrição A dissecção cervical necessita identificação da veia jugular, bifurcação carotídea, e dos nervos cranianos de IX a XII. A mastoidectomia com exposição do canal de falópio, labirinto, ouvido médio e seio sigmoide foi seguida por uma craniotomia transsigmoide com transposição da artéria vertebral, permitindo abordar a região temporal e intracraniana.

Conclusão Acessar o forame jugular é o epítome da cirurgia da base do crânio. Múltiplas modificações do acesso tradicional podem ser necessárias dependendo da extensão do tumor.

Keywords

jugular foramen - schwannoma - meningioma - paraganglioma - skull base neoplasms

Palavras-chave

forame jugular - schwannoma - meningioma - paraganglioma - base do crânio


Publikationsverlauf

Eingereicht: 20. Januar 2021

Angenommen: 16. April 2016

Artikel online veröffentlicht:
31. Januar 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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