Learning objectives
-Review the anatomical relationships of the jugular foramen.
-Describe findings in computed tomography (CT) and Magnetic Resonance (MR) of frequent pathologies and some uncommon.
Background
The structures that run through and surround jugular foramen determine a group of pathologies that requires delicate management.
[1]
It is located in the posterior fossa,
between the occipital bone and petrous pyramid of the temporal bone.
Presents an anteromedial portion (pars nervosa) and a posterolateral portion (pars vascularis) partially separated by the jugular spine,
sometimes it can be completely separated with a fibrous septum.
The pars nervosa contains the IX cranial nerve and the inferior petrosal sinus.
The pars vascularis contains the jugular vein,...
Findings and procedure details
Vascular lesions:
It's important to distinguish the real masses from vascular pseudo masses to avoid an unnecessary biopsy.[5]
Jugular bulb pseudolesion:
CT: Homogeneous mass contiguous to the jugular vein (pseudomass) or enlargement of the pars vascularis.
MR: Slow or turbulent flow can induce loss of the flow void,
mimicking a real mass ( Fig. 2 ).
[3]
Dehiscent jugular bulb:
CT: Essential for diagnosis.
A deficient sigmoid plate can lead the jugular vein to penetrate the middle ear.
MR: Turbulent flow can be confusing.
The...
Conclusion
The composition of the jugular foramen and anatomical relations are essential for diagnosis.
CT detects bone involvement while MR has better soft tissue discrimination.
Paraganglioma is the most frequent lesions in jugular foramen and must be considered among differential diagnosis even in the absence of typical features.
References
1- McGrew B,
Matusz P,
De Caro R,
Loukas M,
Tubbs R,
Griessenauer C.
Surgical Approaches to the Jugular Foramen: A Comprehensive Review.
2019.
2- Guinto G,
Kageyama M,
Trujillo-Luarca V,
Abdo M,
Ruiz-Than A,
Romero-Rangel A.
Nonglomic Tumors of the Jugular Foramen: Differential Diagnosis and Prognostic Implications.
2019.
3- Caldemeyer K,
Mathews V,
Azzarelli B,
Smith R.
The jugular foramen: a review of anatomy,
masses,
and imaging characteristics.
RadioGraphics.
1997;17(5):1123-1139.
4- Vogl T,
Bisdas S.
Differential Diagnosis of Jugular Foramen Lesions.
Skull Base.
2009;19(01):003-016....