Anatomical Variations of the Jugular Foramen Region in Patients with Pulsatile Tinnitus

Lifeng Li; Bentao Yang; Xiaobo Ma; Pingdong Li; Francis X. Creighton; Ricardo L. Carrau; Nyall R. London Jr.

doi:10.1055/s-0040-1722670

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2022; 83(03): 248-253
DOI: 10.1055/s-0040-1722670

Original Article

Anatomical Variations of the Jugular Foramen Region in Patients with Pulsatile Tinnitus

Lifeng Li

¹Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China

,

Bentao Yang

²Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China

,

Xiaobo Ma‡^*

¹Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China

,

Pingdong Li‡^*

¹Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China

,

Francis X. Creighton

³Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

,

Ricardo L. Carrau

⁴Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

,

Nyall R. London Jr.

³Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

› Author Affiliations

Abstract

Objective Structural anomalies of the jugular foramen (JF) and adjacent structures may contribute to development of pulsatile tinnitus (PT). The goal of this study was to assess anatomical variants in the ipsilateral JF region in patients with PT and to explore possible predisposing factors for PT.

Methods One hundred ninety-five patients with PT who underwent CT angiography and venography of the temporal bone were retrospectively analyzed. Anatomic variants including dominance of the ipsilateral JF, bony deficiency of the sigmoid sinus and internal carotid artery canal, high riding or dehiscent jugular bulb, dehiscence of the superior semicircular canal, tumors in the JF region, or cerebellopontine angle were assessed.

Results Of 195 patients with PT, the prevalence of a dominant JF on the ipsilateral side of patients with PT was 67.2%. Furthermore, the dominant JF demonstrated a significant correlation with the presence of ipsilateral PT (p < 0.001). No anatomical variants were present in 22 patients (11.3%), whereas in patients with structural variants, bony deficiency of the sigmoid sinus was most common (65.6%), followed by high riding (54.9%) or dehiscent jugular bulb (14.4%). Dehiscent internal carotid artery canal (3.1%) and superior semicircular canal (4.1%) were occasionally identified, while arteriovenous fistula, arterial aneurysm and tumors arising from the JF region or cerebellopontine angle were rarely encountered.

Conclusion Structural abnormalities of the JF and adjacent structures may predispose to the development of PT. Knowledge of these anatomical variants in the JF region may help establish a clinical strategy for addressing PT.

Keywords

pulsatile tinnitus - jugular foramen - structural anomaly - sigmoid sinus - jugular bulb - dehiscent

Full Text

References

References
1 Truesdale CM, El-Kashlan HK. Pulsatile tinnitus with imaging. JAMA Otolaryngol Head Neck Surg 2018; 144 (05) 451-452
2 Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int 2013; 110 (26) 451-458
3 Wang AC, Nelson AN, Pino C, Svider PF, Hong RS, Chan E. Management of sigmoid sinus associated pulsatile tinnitus: a systematic review of the literature. Otol Neurotol 2017; 38 (10) 1390-1396
4 Berguer R, Nowak P. Treatment of venous pulsatile tinnitus in younger women. Ann Vasc Surg 2015; 29 (04) 650-653
5 Lyu AR, Park SJ, Kim D, Lee HY, Park YH. Radiologic features of vascular pulsatile tinnitus - suggestion of optimal diagnostic image workup modalities. Acta Otolaryngol 2018; 138 (02) 128-134
6 Onder H. Sigmoid sinus dehiscence and suspected idiopathic intracranial hypertension in pulsatile tinnitus?. Neuroradiology 2018; 60 (04) 355-356
7 Mundada P, Singh A, Lingam RK. CT arteriography and venography in the evaluation of Pulsatile tinnitus with normal otoscopic examination. Laryngoscope 2015; 125 (04) 979-984
8 Monsell EM. Regarding evaluation and treatment of pulsatile tinnitus associated with sigmoid sinus wall anomalies. Laryngoscope 2019; 129 (04) E127
9 Sismanis A. Pulsatile tinnitus: contemporary assessment and management. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (05) 348-357
10 Ma XB, Wang GP, Zeng R, Gong SS. Treatment of pulsatile tinnitus associated with multiple factors. Chin Med J (Engl) 2015; 128 (03) 413-414
11 Li L, London Jr NR, Prevedello DM, Carrau RL. Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space. Head Neck 2020; 42 (09) 2734-2740
12 Li L, London Jr NR, Prevedello DM, Carrau RL. Anatomy based corridors to the infratemporal fossa: Implications for endoscopic approaches. Head Neck 2020; 42 (05) 846-853
13 Vaz-Guimaraes F, Nakassa ACI, Gardner PA, Wang EW, Snyderman CH, Fernandez-Miranda JC. Endoscopic endonasal approach to the ventral jugular foramen: anatomical basis, technical considerations, and clinical series. Oper Neurosurg (Hagerstown) 2017; 13 (04) 482-491
14 Tanjararak K, Upadhyay S, Thiensri T. et al. Potential surgical exposure of the parapharyngeal internal carotid artery by endonasal, transoral, and transcervical approaches. J Neurol Surg B Skull Base 2018; 79 (03) 241-249
15 Griessenauer CJ, McGrew B, Matusz P, De Caro R, Loukas M, Tubbs RS. Surgical approaches to the jugular foramen: a comprehensive review. J Neurol Surg B Skull Base 2016; 77 (03) 260-264
16 Ramina R, Maniglia JJ, Fernandes YB. et al. Jugular foramen tumors: diagnosis and treatment. Neurosurg Focus 2004; 17 (02) E5
17 Chari DA, Limb CJ. Tinnitus. Med Clin North Am 2018; 102 (06) 1081-1093
18 Isaacson B, Wick CC, Perez C, Cantrell SC, Killeen DE. Pathophysiology of sensorineural hearing loss in jugular foramen paraganglioma. Laryngoscope 2019; 129 (01) 67-75
19 Lee SY, Song SK, Park SJ. et al. Jugular bulb resurfacing with bone cement for patients with high dehiscent jugular bulb and ipsilateral pulsatile tinnitus. Otol Neurotol 2019; 40 (02) 192-199
20 DeHart AN, Shaia WT, Coelho DH. Hydroxyapatite cement resurfacing the dehiscent jugular bulb: Novel treatment for pulsatile tinnitus. Laryngoscope 2018; 128 (05) 1186-1190
21 Das SS, Saluja S, Vasudeva N. Complete morphometric analysis of jugular foramen and its clinical implications. J Craniovertebr Junction Spine 2016; 7 (04) 257-264
22 Haraldsson H, Leach JR, Kao EI. et al. Reduced jet velocity in venous flow after CSF drainage: assessing hemodynamic causes of pulsatile tinnitus. AJNR Am J Neuroradiol 2019; 40 (05) 849-854
23 Kao E, Kefayati S, Amans MR. et al. Flow patterns in the jugular veins of pulsatile tinnitus patients. J Biomech 2017; 52: 61-67
24 Honkura Y, Hidaka H, Ohta J, Gorai S, Katori Y, Kobayashi T. Surgical treatment for the aberrant internal carotid artery in the middle ear with pulsatile tinnitus. Auris Nasus Larynx 2014; 41 (02) 215-218
25 Van Damme JP, Heylen G, Gilain C, Garin P. Pulsatile tinnitus associated with dehiscent internal carotid artery: an irremediable condition?. Auris Nasus Larynx 2017; 44 (05) 612-615
26 Kim SM, Kim CH, Lee CY. Petrous carotid aneurysm causing pulsatile tinnitus: case report and review of the literature. J Cerebrovasc Endovasc Neurosurg 2018; 20 (01) 35-39
27 Sonmez G, Basekim CC, Ozturk E, Gungor A, Kizilkaya E. Imaging of pulsatile tinnitus: a review of 74 patients. Clin Imaging 2007; 31 (02) 102-108
28 Ginat DT, Gluth MB. Pulsatile tinnitus and a temporal bone mass. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133 (06) 441-442
29 Liu Z, Bi W, Li J. et al. Superior semicircular canal dehiscence in relation to the superior petrosal sinus: a potential cause of pulsatile tinnitus. Clin Radiol 2015; 70 (09) 943-947
30 Darvie P, Storey C, Nanda A, Cuellar-Saenz H. Dural arteriovenous fistula associated with a glomus jugulare tumour presenting with only pulsatile tinnitus. BMJ Case Rep 2018;