IJCRR

IJCRR - Vol 09 issue 10 current issue , May, 2017

Pages: 40-43

Date of Publication: 27-May-2017

Morphometric Evaluation of the Jugular Foramen at Base of the Skull in North Indian Population

Author: Rajkumar, Prabhakaran Kattimuthu, Punita Manik, Kumud Dharwal, Vikram Singh

Category: Healthcare

Abstract:Aim and Objective: The present study is the morphometric evaluation of the dimensions of jugular foramen in regard to the variability in shape and size of jugular foramen and the relationship between antero-posterior diameter (APD) and mediolateral diameter (ML) of jugular foramen on each side (right & left) . The dimensions of the jugular foramen are clinically important because intracranial and extracranial lesions may affect the jugular foramen. The intrinsic abnormalities and pathological processes affecting the jugular foramen are intracranial meningiomas, paragangliomas, schwannomas, metastatic lesions and infiltrative inflammatory processes from surrounding structures such as the middle ear. Other diseases associated with jugular foramen include Vernet's syndrome and Villaret's syndrome.
Methodology: 297dry adult human crania of unknown sex were analyzed from the department of Anatomy, GSVM medical college, Kanpur And KGMU, Lucknow (U.P).
Anteroposterior diameter (APD) of jugular foramen: The maximum anteroposterior diameter of jugular foramen on both right and left sides were measured.
Mediolateral (ML) diameter of jugular foramen: This diameter was taken between medial most and lateral most points of jugular foramen on both right and left sides. Metric measurements were taken by using digital vernier calipers.
Results: The mean anteroposterior diameter of the jugular foramen on the right and left were 15.55\?2.00mm and 14.48\?1.93mm. The mediolatral diameter were 9.33\?1.45 mm and 7.74\?1.63mm on the right and left respectively. The mean area on the right was 114.06\?22.54 mm and on the left 88.90\?25.23 mm.
Conclusion: These findings may be helpful for anatomists and neurosurgeons to approach the cranial base with maximum safety and minimum mortality and morbidity or clinicians in finding the appropriate diagnosis..

Keywords: Jugular foramen, Anteroposterior, Mediolateral, Human Dry Skull

Full Text:

INTRODUCTION

The jugular foramen is a very complicate structure to understand and access surgically; It is difficult to conceptualize because it varies in size and shape in different crania and also on two sides in the same cranium. Another point of difficulty is its formation by two bones, and the numerous nerves and venous channels that pass through it¹.

The jugular foramen lie between the occipital bone and the petrous part of the temporal bone, and can present as much elongated and irregularly shaped foramen². It is the chief route for the venous outflow from the skull. The glossopharyngeal, vagus and cranial part of the spinal accessory nerve passes through this and exit the cranial cavity³.The neural and vascular compartments are generally separated by a bony projection called the intrajugular process^4,5,6.

Recent studies report that the foramen can have many variations in its shape and size. The so-called anomalies of the jugular bulb and glomic tumors are related to the jugular foramen, as they come in direct contact with structures that cross it, like the internal jugular vein, the internal carotid artery, and the cranial nerves. Moreover schwannomas metastatic lesions and infiltrating inflammatory processes can also modify the jugular foramen.²

A knowledge of jugular foramen is necessary in surgical conditions for microsurgical procedures, such as the lateral suboccipital access for the removal of these lesions, which were formerly thought to be very difficult to undergo an operation.^7,8

The tumors involving jugular foramen and nearby structure require microsurgical approach to enter into this region. In most of the cases, we have to drill the nearby bones around the jugular foramen for proper exposure, but the tumor tends to alter the normal anatomy of the foramen by eroding and invading it. Therefore, it is not possible to have correct anatomic visualization of the foramen in the presence of such pathologies. Hence, a detailed knowledge of the jugular foramen is needed to all the neurosurgeons while doing surgery in this region⁹.

The fundamental knowledge of jugular foramen as well as symptoms of these lesions such as loss of hearing, tinnitus, otorrhoea, pain, and paralysis of the facial, glossopharyngeal, vagus, and accessory nerves, is necessary. Dysfunction of these nerves is called syndrome of the jugular fossa (Vernet’s syndrome) which is characterized by: loss of taste sensation in the posterior third of the tongue, paralysis of the vocal cords and soft palate, and weakness of the Trapezius and sternocleidomastoid muscles. If tumors of the jugular foramen region extend medial1y to the hypoglossal canal and cause hypoglossal nerve paralysis, the clinical presentation is known as Collet-Sicard syndrome ^10,11,12 .

Latest information provides a  detailed anatomy of the jugular foramen. Surgical resection is the treatment of choice in the majority of these cases. Advances in microsurgical techniques have made possible the removal of advanced jugular foramen lesions, which were once assumed to be inoperable ¹³.

Knowledge of Intracranial  and  extracranial  lesions  may  affect the  jugular  foramen  in  addition  to  intrinsic  abnormalities. The  pathological  conditions affecting  JF  include  intracranial meningiomas,  paragangliomas, glomusjugulare (jugular  ganglion  of  the vagus  nerve),  schwannomas, metastatic  lesions  and  infiltrative  inflammatory  processes from  adjoining  structures  like  the  middle  ear  ^14,15,16.

Recent studies report that ligation of the internal jugular is sometimes performed  during  radical  neck  dissection  with  the  risk  of venous  infarction,  which  some  adduce  to  be  due  to  ligation of the dominant internal jugular vein. The 9th, 10th and 11^th cranial  nerves  exit  the  cranial  cavity  through  the  JF.  In  the syndrome  of  the  JF  (Vernet’s  syndrome),  there  is  paralysis of  the  9th,  10th  and  11th  cranial  nerves.  These,  along  with paralysis  of  the  12th  cranial  nerve  (Villaret’s  syndrome),occur  with  a  retropharyngeal  lesion  invading  the  posterior fossa.  In  some  instances,  involvement  of  two  or  more  of these  nerves  in  other  combinations  is  encountered  (as  in Jackson’s  vagoaccessory  hypoglossal  paralysis,  Schmidt’s vagoaccessory  syndrome  and  Tapia’s  vagohypoglossal palsy)¹⁷.

MATERIALS AND METHODS:-

• The present study was undertaken in adult north Indian skulls different region of north India, from different medical colleges. The total number of  297 dry adult human crania of unknown sex was analyzed from the Department of Anatomy, GSVM Medical College, Kanpur and King George Medical University, Lucknow (U.P).
• The anteroposterior, and mediolateral  diameters or area of the jugular foramina was determined. Metric measurements were taken by using digital vernier calipers. The mean, standard deviation and range of each dimension and derived index were compared. Right and left side differences were analyzed. Above all parameters were measured both side (right & left) of the jugular foramen.
• Anteroposterior diameter (APD) of jugular foramen:- maximum anteroposterior diameter of jugular foramen  was measured showing no.1.
• Mediolateral (ML) diameter of jugular foramen:- This diameter was taken between medial most and lateral most points of jugular foramen showing no.2.
• Area of the foramen (A): The area of the foramen was calculated using the formula A=π×{A {{D×ML/4}, The areas of both sides the foramina were compared.
• Only fully ossified adult skulls were included in the present study. Skulls  showing wear and tear, any fracture or pathology were excluded.

Statistical Methods

• The statistical analysis used for the study is SPSS (Statistical Package for Social Sciences, IBM).Version 21.

RESULTS

• In the present study, the mean anteroposterior diameter (APD)  of the jugular foramen on right and left were 15.55±2.00mm and 14.48±1.93mm, and mediolatral (ML)  9.33±1.45 mm and 7.74±1.63mm on the right and left sides respectively. The mean area on the right was 114.06±22.54 mm and on the left 88.90±25.23 mm

DISCUSSION:-

• In the present study, the mean anteroposterior diameter of the jugular foramen on right and left were 15.55±2.00mm and 14.48±1.93mm, and mediolatral 9.33±1.45 mm and 7.74±1.63mm on the right and left sides respectively. The mean area on the right was 114.06±22.54 mm and on the left 88.90±25.23 mm (Table no.1).

The comparison of the anteroposterior and mediolaterally diameter of the present study with the study done by other authors is shown in table no.2. The right foramen is larger than the left. These findings are similar to the findings of Hussain Saheb, Vijisa P, Maharshi Abhilasha, Roma Patel, Shruthi B.N, Anjali Singla, Avanish Kumar, Osunwoke E.A,O.E. Idowu shown in table no.2. Some funding is larger than the present study and some finding are smaller than present study.

CONCLUSION

This study provides detailed morphological and morphometric anatomy of the jugular foramen. Knowledge of it is very helpful for neurosurgeons dealing with a space occupying lesion in jugular foramen. These findings may be helpful for anatomists and neurosurgeons to approach the cranial base with maximum safety and minimum mortality and morbidity or clinicians in reaching the appropriate diagnosis.

References:

1. Hussain Saheb S et al A .Morphometric study of the jugular foramen in human adult skulls of south India.  J Biomed Sci and Res., Vol 2 (4), 2010,240-243
2. Pereira GA, Lopes PT, Santos AM. Morphometric aspects of the jugular foramen in dry skulls of adult individuals in Southern Brazil. J Morphol Sci. 2010;27:3–5.
3. Vijisha P, Bilodi AK, Lokeshmaran Morphometric study of jugular foramen in Tamil Nadu region. Natl J Clin Anat. 2013;2:71–4.
4. Hatiboglu MT, Anil A. Structural variations in the jugular foramen of the human skull. J Anat. 1992;180:191–6. [PMC free article] [PubMed]
5.  Prades JM, Martin CH, Veyret CH, Merzougui N, Chelikh L. Anatomic basis of the infratemporal approach of the jugular foramen. Surg Radiol Anat. 1994;16:11–20. [PubMed]
6. Williams P, Warwick R, Dyson M, Bannister L. Gray Anatomia. 37th ed. Vol. 2. Rio de Janeiro: Guanabara Koogan; 1995. pp. 329–31.
7. Guido H, Zorzetto N. Observaçõesanatômicassobre o forame jugular. Rev Bras de Otorrinolaringol. 1997;63:541–7.
8. Idowu OE. The jugular foramen - A morphometric study. Folia Morphol (Warsz) 2004;63:419–22. [PubMed]
9. Singla A, Sahni D, Aggrawal A, Gupta T, Kaur H. Morphometric study of the jugular foramen in North West Indian population. J Postgrad Med Educ Res. 2012;46:165–71.
10.  report. Surgical Neurology 1998; 49: 534–537.
11.   Kumar A., Akhtar J., Kumar A.: Variations in jugular foramen of human skull. Asian Journal of Medical Sciences. 2015; 6 (2): 95–98.
12.   Friedman C.D., Costantino P.D., Teitelbaum B.S.: Primary extracranial meningiomas of the head and  neek. Laryngoscop. 1990; 100: 41–48.
13.  Erongun U., Uyar Y., Çakir B., Uygyn A., Kocaogullar Y.: Infratemporal approach for jugular foramen meningioma. Turkish Neurosurgery. 1993; 3: 128–133.
14.  Chong  VF,  Fan  YF (1998)  Radiology  of the  jugular  foramen. Clinical Radiology, 53:405–416.
15.  Chong  VFH,  Fan  YF  (1996)  Jugular  foramen involvement in  naso-pharyngeal  carcinoma.  J LaryngOtolo- gy, 110: 897–900.
16.  Kanemoto  Y,  Ochiai  C,  Yoshimoto  Y,  Nagai  M  (1998) Primarily  extracranial  jugular  foramen  neurinoma manifesting  with  marked  hemiatrophy  of  the  tongue: case report. Surgical Neurology, 49: 534–537.
17.  Talbert  OR (1990)  General  methods  of clinical examination.  Youman’s  Neurological  Surgery,  3rd  Ed. W.B. Saunders Company, pp. 21
18. Maharshi  Abhilasha e;t al, Morphological  And  Morphometric  Study  Of  Jugular Foramen In Western Rajasthan Population International Journal of Advanced Research and Review(IJARR), 1(8), 2016; 19-24
19. Roma Patel,C.D.Mehta, Morphometric study of Jugular Foramen at base of the skull in South Gujarat region, IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 13, Issue 9 Ver. VII (Sep. 2014), PP 58-61

20. Anjali Sinhla et al, Morphometric Study of  the Jugular Foramen in northwest Indian population ,JPMER, Oct-Dec 2012,46(4):165
21. Avanish Kumar et al,: Variations in jugular foramen of human skull, Asian Journal of Medical Sciences | Mar-Apr 2015 Vol 6 | Issue 2,Page 95-98
22. Osunwoke EA, Oladipo GS, Gwunireama IU, Ngaokere JO.; Morphometric analysis of the foramen magnum and jugular foramen in adult skulls in Southern Nigerian population. Am J Sci Ind Res. 2012;3:446–8.
23. Chandni gupta et al;A morphological and morphometric study of jugular foramen in dry skulls with its clinical implications; J Craniovertebr Junction Spine.2014 Jul-Sep;5(3):118-121