Search

1, Supporting Video 1): The FN was dissected from the genicular ganglion to stylomastoid foramen, the digastric muscle was detached from the digastric ridge and the FN was dissected from the stylomastoid foramen and further dissected to the surface of the styloid process. In a literature review, postoperative grade I or II FN function was achieved in 67.2% of patients who underwent total anterior rerouting.2 Parhizkar et al.4 reported that FN deficits associated with total rerouting of the FN occur may be due to stretching of the nerve or reduced blood supply. Keywords: Jugular foramen paragangliomas; infratemporal fossa type A approach; facial nerve; lower cranial nerves EN Jugular foramen paragangliomas infratemporal fossa type A approach facial nerve lower cranial nerves 2684 2687 4 11/16/21 20211201 NES 211201 INTRODUCTION Jugular foramen paragangliomas (JFPs) are highly vascularized tumors, although JFPs grow slowly and are considered histologically benign, the infiltrative nature of tumors tend to destroy vital neurovascularities adjacent to tumor. Our modified total anterior FN transposition technique not only reduced FN tension but also maintained blood supply of the FN by ensuring minimal FN injury and degeneration, which lead to significant improvement of FN function postoperatively. [Extracted from the article]

Lesions arising from the upper parapharyngeal space (UPPS) often involved the jugular foramen region (JFR), occasionally extending into the posterior cranial fossa. This study aims to investigate the surgical anatomy of the JFR and UPPS from the perspective of an expanded endoscopic approach (EEA), tracing the lower cranial nerves from their extracranial foramina to the UPPS. Six cadaveric specimens (12 sides) underwent a transpterygoid EEA to expose the JFR and UPPS. Distances from the medial pterygoid plate (MPP) to the internal carotid artery (ICA), hypoglossal canal (HC), and jugular tubercle (JT) were measured on anonymized Computed tomography angiography images previously obtained from 30 patients with pulsatile tinnitus. Full access to the JFR, and its medial, superior, and anterior aspects, could be adequately achieved via an EEA. Upon exiting the jugular foramen, the glossopharyngeal nerve courses posterior to the ICA, traveling inferiorly into the UPPS between ICA and IJV. The vagus nerve is in close proximity to the hypoglossal nerve traveling posterior to the ICA. The accessory nerve courses lateral to the vagus nerve, running posterior to the IJV. The minimal distances from the MPP to ICA, HC, and JT were 2.52 ± 0.34, 2.86 ± 0.36, and 3.18 ± 0.33 cm, respectively. This anatomical study strongly suggests the feasibility of using an EEA to access to the medial, superior, and anterior aspects of the jugular foramen and the adjacent UPPS. [ABSTRACT FROM AUTHOR]

Objective: We report an association between lower cranial nerve (CN IX/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non-neurosurgical treatments are detailed.Study Design: Retrospective chart review at a tertiary care academic medical center with follow-up telephone survey.Methods: Baseline demographics, clinical characteristics, quality-of-life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem.Results: Forty-nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice-Related Quality of Life (V-RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty-four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near-complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete/near-complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (P = 0.02). V-RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (P = 0.03) (mean follow-up 3.0 years, SD 2.0).Conclusion: Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile.Level Of Evidence: 4 Laryngoscope, 129:2105-2111, 2019. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to share our review of surgical strategies and long-term outcomes in the management of tympanojugular paragangliomas. Methods This was a retrospective study with a literature review. The records of 184 patients with 185 tympanojugular paragangliomas were analyzed for tumor class, surgical procedure, preoperative vascular management, and perioperative sequelae. Results Of class C1, C2, C3, and C4 tumors, we found 46 (24.9%), 95 (51.3%), 41 (22.2%), and 3 (1.6%), respectively. One hundred four (56.2%) tumors had intracranial extensions and 8 (4.3%) involved the vertebral artery. A single-stage procedure was adopted in 158 (85.4%) tumors. The infratemporal fossa type A approach was used in all cases. In 17 patients (9.7%), an intra-arterial stenting of the internal carotid artery was performed. Gross-total tumor removal was achieved in 166 cases (89.7%) and 4 (2.4%) among them developed a recurrence. Conclusion A thorough understanding of skull base techniques and a logical decision-making process in the management of tympanojugular paragangliomas can achieve a high rate of success in terms of recurrences and complications. © 2015 Wiley Periodicals, Inc. Head Neck 38: 871-885, 2016 [ABSTRACT FROM AUTHOR]