The Experts below are selected from a list of 129 Experts worldwide ranked by ideXlab platform
Robert K Jackler - One of the best experts on this subject based on the ideXlab platform.
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transJugular craniotomy for the management of Jugular foramen tumors with intracranial extension
Otology & Neurotology, 2004Co-Authors: John S Oghalai, Robert K Jackler, Mankit Leung, Michael W McdermottAbstract:Objectives To elucidate indications and outcomes with the transJugular craniotomy for resection of Jugular foramen tumors with intracranial extension. The transJugular approach is a lateral craniotomy conducted through a partial petrosectomy traversing the Jugular Fossa combined with resection of the sigmoid sinus and Jugular bulb, which often have been occluded by disease. Study design Retrospective review. Setting University medical center. Patients Twenty-eight patients with intracranial Jugular foramen tumors who underwent a total of 30 surgical procedures. Main outcome measures Pathologic findings, surgical approach, extent of tumor resection, rate of facial nerve mobilization and ear canal closure, facial and lower cranial nerve outcomes, and hearing preservation. Results Tumors included schwannoma (37%), meningioma (33%), glomus Jugulare (23%), and chordoma (7%). The surgical approaches were tailored to maximize functional preservation, and included the transJugular (53%), translabyrinthine (17%), retrosigmoid (10%), and far lateral (7%) craniotomies. Translabyrinthine (3%) or transcondylarfar lateral (3%) approaches were occasionally used in combination with the trans-Jugular approach. Most procedures were managed in a single stage (90%), but three patients with massive tumor in the neck required two stages. Microsurgical gross total and near-total tumor removal (37% each) were commonly achieved, although subtotal resections (27%) were occasionally performed. In only a minority of cases was facial nerve mobilization (7%) or ear canal closure (21%) required. If present preoperatively, Grade I facial nerve function was usually maintained (22 of 24 [92%]) and Hearing Class A or B could always be maintained (9 of 9 [100%]). As expected, new lower cranial nerve dysfunction was common (8 of 30 [27%]), although over half of the patients had complete lower nerve palsy preoperatively (16 of 30 [53%]). Conclusion Most patients with Jugular foramen tumors with intracranial extension can be managed with a single-stage transJugular craniotomy. Facial nerve mobilization or ear canal closure is usually not required, permitting conservation of facial function and hearing, when present preoperatively.
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removal of Jugular foramen tumors the fallopian bridge technique
Otolaryngology-Head and Neck Surgery, 1997Co-Authors: Myles L Pensak, Robert K JacklerAbstract:Despite recent advances in neuroradiographic and electrophysiologic assessment, the surgical extirpation of lesions of the bony skull base remains challenging. Moreover, as surgeons have gained experience in removing tumors from the irregular osteologic confines of the skull base, attention has been directed toward preservation of vital neural and vascular structures traversing the operative field. This report describes the creation of a fallopian bridge with preservation of the facial nerve in removing tumors that arise within or juxtaposed to the Jugular Fossa. Thirty-five patients are reported herein with analysis of pathology, surgical approach, and outcome. An algorithm for use of the fallopian bridge, as opposed to facial nerve mobilization and rerouting, is presented with particular emphasis on limitation of this selective procedure.
Ossama Almefty - One of the best experts on this subject based on the ideXlab platform.
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Jugular Fossa lesions
Contemporary neurosurgery, 2002Co-Authors: Kenan I Arnautovic, Ossama AlmeftyAbstract:lar foramen. It lodges the Jugular bulb, which continues into the Jugular vein inferiorly (Fig. 1). In the neurosurgical literature, and even in extensive anatomic studies, both the Jugular foramen and the Jugular Fossa often are referred to by the term "Jugular foramen." This use of the term may be the result either of simple error or the user's wish to provide a broader anatomic description of the area, and this confusion may be the underlying reason for the current lack of agreement regarding the internal anatomic organization of "the Jugular foramen." Regardless of the reason for this mix-up, the Jugular foramen and the Jugular Fossa are two distinct anatomic formations, although they are intimately related. The treatment of Jugular Fossa lesions has been revolutionized by the development of modern diagnostic modalities, refinement of microsurgical techniques, publication of microsurgical anatomic studies, development of skull base approaches, advances in neuroanesthesia and intraoperative neurophysiologic monitoring, and careful multidisciplinary perioperative planning. These lesions now are treated with radical resection, and the rates of permanent surgical morbidities or mortalities are low.
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primary meningiomas of the Jugular Fossa
Journal of Neurosurgery, 2002Co-Authors: Kenan I Arnautovic, Ossama AlmeftyAbstract:Object. Primary Jugular Fossa meningomas (JFMs) are one of the rarest subgroups of meningioma, with fewer than 40 cases reported in the literature. The authors retrospectively analyzed the results of surgical treatment in their series of patients, including clinical, pathological, and complication features. The surgical approach was mandated by the pathological anatomy of the tumor as well as by the anatomy of the individual patient. Methods. During a 6.5-year period, the authors performed nine surgeries in eight patients (seven women [88%] and one man [12%]) with JFMs. Six lesions occurred on the right side and two on the left. The most common presenting symptoms were altered hearing in five patients (62%), swallowing difficulties in four patients (50%), and a deficit of the 11th cranial nerve in three patients (38%); a combination of two or more signs or symptoms was common. The surgical approach was tailored to the local anatomy (tumor—neurovascular relationships) found in each patient; three different...
Michael E Glasscock - One of the best experts on this subject based on the ideXlab platform.
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cranial nerve preservation in lesions of the Jugular Fossa
Otolaryngology-Head and Neck Surgery, 1991Co-Authors: Gary C Jackson, Roberto A Cueva, Britt A Thedinger, Michael E GlasscockAbstract:The most significant objection to the proposal of lateral transtemporal cranial base surgery for the treatment of Jugular foramen tumors is the perceived lasting morbidity attendant to aggregate cranial nerve loss. As techniques become more standardized and earlier diagnosis generates smaller tumors for treatment, outcome has become more predictable. Surgery has become the recognized management preference for these cranial base lesions. The purpose of this article is to assess the role of surgery in the treatment of Jugular foramen lesions, as well as to review some of the technical highlights of conservation surgery, its clinical prerequisites, and reasonable expectations. We review 100 lateral skull base surgical cases of lesions involving the Jugular foramen. The majority of these lesions--77 of 100--were paragangliomas. For these glomus tumors, cranial nerve preservation correlated well to tumor size and location. The diversity of the remaining 23 cases prevented any substantive conclusions.
Audie L Woolley - One of the best experts on this subject based on the ideXlab platform.
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55 major vascular injuries in children undergoing myringotomy for tube placement
Otolaryngology-Head and Neck Surgery, 1996Co-Authors: Brian N Brodish, Audie L WoolleyAbstract:The temporal bone is home to some of the largest vascular structures encountered in the head and neck region. Both the internal carotid artery and the internal Jugular vein traverse the temporal bone emoute from the neck to the cranial vault. Knowledge of the normal anatomic position of these structures is crucial in minimizing the risk for major vascular injuries during otologic surgery. The internal carotid artery normally enters the temporal bone through the carotid canal, beginning just medial to the styloid process. It ascends vertically anterior to the tympanic cavity, then bends sharply anteriorally and medially. It passes inferior to the eustachian tube, then through the foramen lacerum to enter the cranium at the petrous apex.l The Jugular bulb forms the connecting link between the internal Jugular vein inferiorly and the sigmoid and inferior petrosal sinuses superiorly. It normally rests in the Jugular Fossa, which is a hollowed concavity in the undersurface of the petrous bone beneath the middle ear cavity. It averages 15 mm wide ~2 mm high and is larger on the right in 75% of the patients because the contributing transverse sinus tends to be larger on the right.2-” Both the internal carotid artery and the Jugular bulb are normally encased in compact bone. This anatomic feature, and the surgeon’s
William T Couldwell - One of the best experts on this subject based on the ideXlab platform.
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dramatic radiographic response resulting in cerebrospinal fluid rhinorrhea associated with sunitinib therapy in recurrent atypical meningioma case report
Journal of Neurosurgery, 2017Co-Authors: Amol Raheja, Howard Colman, Cheryl A Palmer, William T CouldwellAbstract:Sunitinib is a multiple tyrosine kinase inhibitor with antiangiogenic, cytostatic, and antimigratory activity for meningiomas. A recent clinical trial of sunitinib for treatment of recurrent Grade II and III meningiomas suggested potential efficacy in this population, but only 2 patients exhibited significant radiographic response with tumor volume reduction. The authors illustrate another such case and discuss a complication related to this dramatic tumor volume reduction in aggressive skull base meningiomas.The authors describe the case of a 39-year-old woman who had undergone repeat surgical interventions and courses of radiotherapy over the previous 11 years for recurrent cranial and spinal meningiomas. Despite 4 operations over the course of 4 years on her right petroclival meningioma with cavernous sinus and Jugular Fossa extensions, she had progressive neurological deficits and tumor recurrences. The specimen histology progressed from WHO Grade I initially to Grade II at the time of the third recur...
