Sudden sensorineural hearing loss from a Jugular Bulb Diverticulum

@#A 19-year-old woman presented with an 11-month history of sudden-onset left sided hearing loss accompanied by vertigo and headache. Audiometric testing revealed profound left- sided hearing loss. A contrast-enhanced MRI of the internal auditory canal performed 5 months after symptom onset was interpreted as showing a vascular loop, probably the anterior inferior cerebellar artery, abutting and indenting on the left vestibulocochlear nerve; and a prominent and high-riding left jugular bulb. In this study, the internal auditory canals were assessed to be of normal width, with walls that were smooth and sharply defined. A cerebral CT angiogram subsequently performed did not show any abnormal findings related to the previously identified vascular loop. On the basis of these radiologic findings, the patient was advised surgery by physicians at a tertiary- care institution, presumably to address the identified vascular loop. A second opinion was sought by the patient.

A Case of Posterior Semicircular Canal Dehiscence Caused by High Jugular Bulb / 대한이비인후과학회지

Posterior semicircular canal dehiscence represents a third-window lesion manifesting as hearing loss with vestibular dysfunction. Computed tomography findings of a dehiscent posterior canal can be verified with increased vestibular evoked myogenic potential responses as in other third-window lesions. The jugular bulb is the bulbiform connection between the sigmoid sinus and the internal jugular vein at the skull base. High jugular bulb can erode into inner ear structures. According to the literature review, there has been no case report about posterior semicircular canal dehiscence caused by high jugular bulb in Asia. Therefore, the authors report a case with a review of literature.

Effects of hyperventilation on jugular bulb pressure and optic nerve sheath diameter during robotic laparoscopic radical prostatectomy / 实用医学杂志

Objective To observe the effects of hyperventilation on jugular bulb pressure and optic nerve sheath diameter during RALRP. Methods Twenty patients undergoing elective RALRP were enrolled in this study. After hyperventilation of General anesthesia,we monitored and recorded changes of Heart rate(HR),mean arterial pressure (MAP),end-tidal carbon dioxide (ETCO2),arterial oxygen tension (PaO2),arterial carbon dioxide tension(PaCO2),peak airway pressure(PIP),JBP and ONSD in 5 minutes after intubation(T0),Trendelenberg posture in 15 minutes (T1),the established pneumoperitoneum in 30,60,90 minutes (T2,T3,T4) and termination of pneumoperitoneum in 15 minutes in supine position(T5)respectively. Results Compared with T0, JBP increased at T1 ~ T5(P < 0.05). ETCO2 and PaCO2 of T1 ~ T5 were lower than those of T0(P < 0.05)during hyperventilation. After establishment of Trendelenburg posture and pneumoperitoneum,PIP values increased at T1~T4 than that at T0 (P < 0.05),However,ONSD increased from T3 to T5 compared with T1 to T2 (P < 0.05). Conclusion Through over-ventilation,pneumoperitoneum and Trendelenburg posture,JBP and PIP can increase, and ONSD becomes wider evendually.

The Age-Related Orientational Changes of Human Semicircular Canals

OBJECTIVES: Some changes are found in the labyrinth anatomy during postnatal development. Although the spatial orientation of semicircular canals was thought to be stable after birth, we investigated the age-related orientational changes of human semicircular canals during development. METHODS: We retrospectively studied the computed tomography (CT) images of both ears of 76 subjects ranged from 1 to 70 years old. They were divided into 4 groups: group A (1-6 years), group B (7-12 years), group C (13-18 years), and group D (>18 years). The anatomical landmarks of the inner ear structures were determined from CT images. Their coordinates were imported into MATLAB software for calculating the semicircular canals orientation, angles between semicircular canal planes and the jugular bulb (JB) position. Differences between age groups were analyzed using multivariate statistics. Relationships between variables were analyzed using Pearson analysis. RESULTS: The angle between the anterior semicircular canal plane and the coronal plane, and the angle between the horizontal semicircular canal plane and the coronal plane were smaller in group D than those in group A (P<0.05). The JB position, especially the anteroposterior position of right JB, correlated to the semicircular canals orientation (P<0.05). However, no statistically significant differences in the angles between ipsilateral canal planes among different age groups were found. CONCLUSION: The semicircular canals had tendencies to tilt anteriorly simultaneously as a whole with age. The JB position correlated to the spatial arrangement of semicircular canals, especially the right JB. Our calculation method helps detect developmental and pathological changes in vestibular anatomy.

Evidencias en la utilidad de la saturación yugular de oxígeno como método de neuromonitoreo y guía de tratamiento / Evidence on the usefulness of jugular oxygen saturation as a neuromonitoring method and treatment guide

El manejo del paciente con injuria cerebral aguda ha tenido grandes avances en la última década. Neurocirujanos y Neurointensivistas cuentan cada vez con más y mejores métodos de monitoreo que colaboran en la prevención del daño secundario. A pesar de esto, aún no contamos con consensos que permiten decidir cual método de monitoreo utilizar en cada patología en particular. Estamos en permanente revisión para definir cuál es el método más preciso y efectivo en la medición de datos de relevancia que permitan aplicar una terapéutica más racionalmente orientada. Esta revisión ha llegado al punto de cuestionar la efectividad del monitoreo de la Presión Intracraneana en el Trauma Encéfalo Craneano Grave. Más allá de la relevancia de los cambios inflamatorios que alteran la presión intracraneana, la pérdida de la autorregulación determina un alto riesgo de complicaciones en la primera semana del paciente neurocrítico, independientemente de la causa de injuria primaria. Los trastornos del Flujo Sanguíneo Cerebral (FSC) subyacentes parecen jugar un papel de importancia en la generación del daño secundario. A fin de poder monitorear estos eventos potencialmente nocivos, se han desarrollado métodos de medición indirecta del FSC como el Doppler transcraneano (DTC), Saturación Yugular de Oxígeno (SayO2), Espectrometría Cercana al Infrarrojo (Near infrared) y Presión Tisular de Oxígeno (PtiO2) En esta revisión focalizaremos nuestra atención en describir las evidencias en la utilidad de la SayO2 como método de monitoreo y como guía de tratamiento

The management of patients with acute brain injury has made great advances in the last decade. Neurosurgeons and Neurointensivists have more and better monitoring methods which cooperate in the prevention of secondary damage. Despite this, we still have not consensus on deciding which monitoring method is going to be used in each particular pathology.We are constantly reviewing of which method is more accurate and effective in measuring relevant data to help guiding a therapy more rationally oriented. This ongoing review has reached the point of questioning the effectiveness of monitoring of Intracranial Pressure in Severe Trauma Brain Injury. Beyond the relevance of inflammatory changes with changes in intracranial pressure, the loss of autoregulation determines a high risk of complications in the first week of neurocritical patients, regardless the cause of the primary injury. Disorders of Cerebral Blood Flow (CBF) underlying seem to play an important role in the generation of secondary damage. In order to monitor these potentially harmful events there have been developed indirect measurement methods FSC and transcranial Doppler (TCD), Jugular Oxygen Saturation (SayO2) Near-Infrared Spectroscopy and Tissue Oxygen Pressure (PtiO2) In this review we will focus on describing the evidence on the usefulness of the SayO2 as a method to guide monitoring and treatment

Cerebral Oxygenation during Laparoscopic Surgery: Jugular Bulb versus Regional Cerebral Oxygen Saturation

PURPOSE: We hypothesized that regional cerebral oxygen saturation (rSO2) could replace jugular bulb oxygen saturation (SjvO2) in the steep Trendelenburg position under pneumoperitoneum. Therefore, we evaluated the relationship between SjvO2 and rSO2 during laparoscopic surgery. MATERIALS AND METHODS: After induction of anesthesia, mechanical ventilation was controlled to increase PaCO2 from 35 to 45 mm Hg in the supine position, and the changes in SjvO2 and rSO2 were measured. Then, after establishment of pneumoperitoneum and Trendelenburg position, ventilation was controlled to maintain a PaCO2 at 35 mm Hg and the CO2 step and measurements were repeated. The changes in SjvO2 (rSO2) -CO2 reactivity were compared in the supine position and Trendelenburg-pneumoperitoneum condition, respectively. RESULTS: There was little correlation between SjvO2 and rSO2 in the supine position (concordance correlation coefficient=0.2819). Bland-Altman plots showed a mean bias of 8.4% with a limit of agreement of 21.6% and -4.7%. SjvO2 and rSO2 were not correlated during Trendelenburg-pneumoperitoneum condition (concordance correlation coefficient=0.3657). Bland-Altman plots showed a mean bias of 10.6% with a limit of agreement of 23.6% and -2.4%. The SjvO2-CO2 reactivity was higher than rSO2-CO2 reactivity in the supine position and Trendelenburg-pneumoperitoneum condition, respectively (0.9+/-1.1 vs. 0.4+/-1.2% mm Hg-1, p=0.04; 1.7+/-1.3 vs. 0.5+/-1.1% mm Hg-1, p<0.001). CONCLUSION: There is little correlation between SjvO2 and rSO2 in the supine position and Trendelenburg-pneumoperitoneum condition during laparoscopic surgery.

The prognostic value of bispectral index in patients with acute cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To evaluate the prognostic role of bispectral index (BIS) monitoring in patients after cardiopulmonary resuscitation (CPR) in the intensive care unit (ICU).Methods Thirtythree adult patients after CPR were enrolled and divided into survived group and non - survived group as per 7-day survival.During their stay in the ICU,BIS and SaO2 (saturation of artery oxygen) levels of all the patients were continuously monitored.The neurological status of the patients was measured with Glasgow coma scale (GCS).Acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) was used to evaluate the patient condition. SjO2 (saturation of jugular bulb venous oxygen ) levels of 23 patients were continuously monitored and then the difference in values between SaO2 and SjO2 was calculated to show oxygen metabolism in the brain. The studied variables were compared between the two groups. The correlations between BIS values and GCS scores,and between BIS and APACHE Ⅱ scores were respectively analyzed. Results The BIS values and difference in values between the SaO2 and SjO2 were significantly higher in the patients of survived group than those in the patients of non-survived group (P ＜0.01 ).There were positive correlation between BIS and GCS (r =0.821,P ＜ 0.01 ) and as well as positive correlation between BIS and APACHE- Ⅱ ( r =0.434,P ＜ 0.05 ).Conclusions The BIS may be useful to predict the post - resuscitative outcome of patients after cardiopulmonary resuscitation.

A Case of Jugular Bulb Diverticulum Invading the Internal Auditory Canal

Jugular bulb diverticulum (JBD) is a rarely reported vascular anomaly, which is an extraluminal outpouching from the jugular bulb. Especially, there exists a lack of reported cases involving JBD encroaching the internal auditory canal (IAC) in Korea. Subjects with JBD may be asymptomatic or have variable symptoms based on its location and size. In this article, we report a unique case of JBD eroding into the IAC that was presented as sudden sensorineural hearing loss with vertigo.

A Case of Pulsatile Tinnitus from Dehiscent High Jugular Bulb Treated by Reconstruction of the Hypotympanum / 대한이비인후과학회지

Vascular tinnitus, a sort of pulsatile tinnitus, should be differentiated with other sensorineural tinnitus because it is possible to be cured by correction of underlying systemic disease or surgery. The dehiscent high jugular bulb, a common cause of venous pulsatile tinnitus, can be cured by reconstruction of hypotympanum. We present a case of pulsatile tinnitus with dehiscent high jugular bulb which has been treated by surgery. Preoperative microscopic finding showed dark bluish pulsating mass in posteroinferior portion of tympanic membrane. Temporal bone CT showed high jugular bulb with bone defect of hypotympanum. The hypotympanum was reconstructed and high jugular bulb lowered using the harvested bony fragment from mastoid cortical bone. The pulsatile tinnitus disappeared immediately after surgery.

Comparison between Regional Cerebral Oxygen Saturation and Jugular Bulb Venous Oxygen Saturation in Patients Undergoing OPCAB Surgery / 대한마취과학회지

BACKGROUND: Hypoperfusion during manipulation of the heart in off-pump coronary artery bypass (OPCAB) surgery may lead to postoperative neurological complications. Therefore, it will be necessary to monitor cerebral function during OPCAB surgery. In this study, we compared regional cerebral oxygenation (rSO2) by near-infrared spectroscopy (NIRS) with jugular bulb venous oxygen saturation (SjvO2) and assessed whether rSO2 measured by NIRS could be an alternative method of SjvO2 during OPCAB surgery. METHODS: A total of 20 patients who underwent OPCAB surgery were studied. A fiberoptic catheter was placed in the right jugular bulb to measure SjvO2 while a cerebral oximeter based on NIRS, INVOS 5100B was used to monitor rSO2. Radial arterial and jugular bulb blood samples were drawn simultaneously from baseline every hour during operation. The values of rSO2 were compared with SjvO2 values. RESULTS: For all data points (n = 78) for all patients combined, rSO2 values were significantly correlated with SjvO2 values (r = 0.513, P < 0.0001). There were significant correlations between arterial carbon dioxide and values of SjvO2 (r = 0.393, P = 0.0002) and rSO2 (r = 0.432, P < 0.0001). CONCLUSIONS: We concluded that NIRS correlates with SjvO2 in this patient population. These findings suggest that near-infrared spectroscopy may be useful in assessing cerebral oxygenation during OPCAB surgery.

Total Intravenous Anesthesia for Open Heart Surgery in a Patient with a Moyamoya Disease: A case report / 대한마취과학회지

Moyamoya disease (MMD) is a progressive cerebrovascular occlusive disease of the internal carotid arteries and anterior and middle cerebral arteries. Non-neurological surgery in patients with MMD is often complicated by cerebral ischemia or infarction. The goals of perioperative management are to maintain normotension, normocarpnia, normovolemia and normothermia. Here we report a case of a patient with MMD who underwent patch closure of an atrial septal defect and pulmonary valvotomy by use of a normothermic and non-hemodiluted cardiopulmonary bypass. To prevent intraoperative neurological complications we performed total intravenous anesthesia with propofol, made burst suppression in EEG and monitored the jugular bulb oxygen saturation (SjvO2) for cerebral desaturation.

Cerebral protective effect of desflurane anesthesia during craniotomy / 中国康复理论与实践

@#Objective To determine the cerebral protective effect of different concentrations of desflurane anesthesia during craniotomy.Methods Twenty two patients, scheduled for selective craniotomy for resections of supratentorial mass lesions, were anesthetized by inhalation of desflurane. When the concentrations of desflurane were maintained at 0.7,1.0 and 1.3 mean alveolar concentration (MAC) for 30 min during removing the tumor, venous blood samples which were drawn through internal jugular bulb were analyzed. Mean arterial pressure (MAP), heart rate (HR), and jugular bulb pressure (JBP) were recorded during the craniotomy.Results Jugular bulb oxygen saturation (SjO2) was significantly declined at 1.0 and 1.3 MAC compared with that at 0.7 MAC (P<0.05 and P<0.01 respectively). There was no significant changes in SjO2 between 1.0 and 1.3 MAC (P>0.05). MAP declined dose dependently, and decreased more significantly at 1.3 MAC (P<0.01).HR and JBP increased slightly with the raising concentration of desflurane but there were no significant changes at any MAC of desflurane (P>0.05).Conclusion Desflurane anesthesia at 1.0 MAC shows cerebral protection effect during craniotomy with stable hemodynamics and improved cerebral oxygen supply and demand.

Effect of Clonidine Supplementation on Jugular Bulb Oxygen Saturation and Carbon Dioxide Reactivity during Desflurane Anesthesia / 대한마취과학회지

BACKGROUND: The alpha2-agonist clonidine is an adjunct in general anesthesia. Clonidine constricts cerebral arteries and decreases cerebral blood flow (CBF), but does not alter cerebral metabolic rate (CMR). Thus cerebral ischemia is possible due to CBF/CMR imbalance. This study was designed to prove the effects of clonidine bolus up on CBF and CO2 reactivity in desflurane anesthesia. METHODS: Thirty patients were divided into a clonidine group (n = 15) and a control group (n = 15). Anesthesia was induced with thiopental and pancuronium, and maintained with 50% N2O/O2/ Desflurane. The jugular bulb was cannulated to measure jugular bulb oxygen saturation (SjO2). MAP and SjO2 were measured after induction, after clonidine (2 microgram/kg) or normal saline administration and during hyperventilation. RESULTS: After clonidine administration, MAP decreased from 95.7+/-9.8 mmHg to 81.1+/-6.3 mmHg and was 79.9+/-5.0 mmHg during hyperventilation. In the control group, the corresponding MAP values 95.7+/-9.8 mmHg, 81.1+/-6.3 mmHg and 79.9+/-5.0 mmHg. After clonidine administration, SjO2 was decreased from 84.7+/-3.7% to 81.1+/-5.2%, and was 71.5+/-8.4% during hyperventilation (P = 0.003, P = 0.000) and in control group, there were 95.7+/-9.8%, 81.1+/-6.3% and 79.9+/-5.0%, respectively. CO2 reactivity was expressed as a change of SjO2 per unit change of PaCO2, 1.15+/-1.19%/mmHg versus 1.43+/-0.98%/mmHg (P = 0.49). CONCLUSIONS: During desflurane anesthesia, clonidine-induced constriction of the cerebral arteries was demonstrated but CO2 reactivity was well preserved.

Reliability of rSO2 to Measure CO2 Reactivity of Cerebral Vasculatures during Desflurane-N2O Anesthesia / 대한마취과학회지

BACKGROUND: Near infrared spectroscopy (NIRS) to monitor regional cerebral oxygen saturation (rSO2) is a noninvasive and simple modal ity in clinical use. The ability of rSO2 as an index of cerebral oxygenation has been well demonstrated. However, the reliability of rSO2 to reflect the changes of cerebral vascular reactivity in the changes of arterial partial pressure of CO2 (PaCO2) has not been established. The aim of this study was to verify the reliability of rSO2 to measure the CO2 reactivity of cerebral vasculatures. METHODS: Twenty healthy adult patients undergoing general anesthesia were enrolled in this study. Anesthesia was induced with propofol and maintained with desflurane/N2O. Respiration was mechanically controlled. The radial artery and jugular bulb were cannulated. The sensor of the NIRS was attached to the ipsilateral forehead. During normocapnia (PaCO2 40 +/- 1.3 mmHg) and hypocapnia (PaCO2 30 +/- 2.4 mmHg), blood was obtained from the radial artery and jugular bulb and analyzed. rSO2 was compared with fSO2 (estimated field oxygen satuation), and the gold standard of tissue oxygen saturation. fSO2 was calculated from the following equation: fSO2 = 0.75 SjO2 + 0.25 SaO2. RESULTS: rSO2 significantly correlated with fSO2 (P = 0.000, r2 = 0.56). A bias of - 5.8% with a precision 12.94% was found. CONCLUSIONS: We concluded that rSO2 can be a reliable predictor to measure CO2 reactivity of cerebral vasculatures during normocapnia and hypocapnia.

A Case of High Jugular Bulb Associated with Conductive Hearing Loss / 대한이비인후과학회지

A high jugular bulb is often discovered as an incidental finding that is asymptomatic. The incidence of high jugular bulb protruding into the level of oval window is rare. Conductive hearing loss in association with this anomaly may occur, but has been reported infrequently in the literature. We report one case of high jugular bulb and the associated conductive hearing loss. Mechanisms to explain the conductive hearing loss include contact of the jugular bulb with tympanic membrane, interference with the ossicular chain, and obstruction of the round and oval window niche. The operative findings, radiographic and audiometric data that support these mechanisms of couductive hearing loss are presented.

Difference of Jugular Bulb Oxygen Saturation under Propofol, Enflurane and Isoflurane Anesthesia with Hydralazine-induced Deliberate Hypotension / 대한마취과학회지

BACKGROUND: Hydralazine produces cerebral vasodilation, which could appear differently according to which kind of anesthetics was used. SjO2, CBF and AJDO2 have been studied during general anesthesia with enflurane, isoflurane or propofol in 42 patients undergoing spinal surgery. METHODS: Forty-two healthy adult patients were divided into Group P (Propofol-N2O, n = 15), Group E (Enflurane-N2O, n = 15) and Group I (Isoflurane-N2O, n = 12). During the course of the study, the anesthetic concentration was constant. Induced hypotension was provided with hydralazine 20 mg in combination with a continuous infusion of esmolol within 50 - 100ng/kg/min. Arterial blood and jugular bulb blood were obtained and analyzed at normotensive and hypotensive period, respectively. SjO2, was compared within and between groups. RESULTS: SjO2 values of Group P were 66.2 +/- 7.7%, and 81.5 +/- 6.1%, those of Group E were 79.5 +/- 5.6%, and 78.9 +/- 4.9% and those of Group I were 82.0 +/- 6.2%, and 84.4 +/- 3.7% at normotension and hypotension, respectively (P < 0.05 between Group P and Group E, P < 0.05 between Group P and Group I, P < 0.05 within Group P). CONCLUSIONS: When the changes of CBF is assumed with that of SjO2, it may be concluded that CBF increased with hydralazine-induced hypotension in propofol-N2O anesthesia. It may be suggested that hydralazine reverses propofol induced cerebral vasoconstriction.

The Effects of Normocapnia and Hypercapnia on Venous Oxygen Saturation and Lactate Levels at the Jugular Bulb during Rewarming from Hypothermic Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Neurologic and neuropsychologic dysfunction after cardiopulmonary bypass is frequent and can be caused by inadequate cerebral perfusion and oxygenation. A decrease of SjvO2 suggests a situation in which the oxygen supply to the brain is insufficient to meet metabolic demands. This study investigated the effects of normocapnia and hypercapnia on changes in SjvO2 and lactate levels during rewarming from hypothermic cardiopulmonary bypass. METHODS: Anesthesia was induced and maintained with bolus and continuous infusion of fentanyl, midazolam and vecuronium. Patients were assigned to a normocapnic (PaCO2: 35 - 40 mmHg, n = 10) or hypercapnic (PaCO2: 45 50 mmHg, n = 10) group during rewarming. SjvO2 and lactate levels at the jugular bulb were measured at 30, 34 and 37degrees C nasopharyngeal temperature. RESULTS: There was not a reduction in SjvO2 to < 50% in normocapnic and hypercapnic group during the rewarming period, and there was no significant difference in lactate levels at the jugular bulb. However, the hypercapnic group had a higher SjvO2 than the normocapnic group at 30, 34 and 37degrees C nasopharyngeal temperature during rewarming (P<0.05). CONCLUSIONS: Hypercapnia is more effective increasing SjvO2 than normocapnia and may contribute to the prevention of postoperative neurologic dysfunction, especially in patients having a low SjvO2.

Effects of Propofol Used with an Inhalation Anesthetic in the Neuroanesthetic Management on the Jugular Bulb Oxygen Saturation / 대한마취과학회지

BACKGROUND: When we use a volatile anesthetic that increases cerebral blood flow (CBF) and propofol which decreases CBF in appropriate doses, respectively, an increase in ICP and cerebral ischemia can be prevented. The purpose of this study was to look for the proper method for balanced anesthesia using a jugular bulb oxygen saturation (SjO2) that depends on the concentration of propofol used in combination with isoflurane-N2O anesthesia. METHODS: Randomly we divided these patients into group 1 (12 patients), group 2 (12 patients), and group 3 (15 patients). Using a Master TCI and injecting a volatile anesthetic continuously, we injected 2ng/ml of blood concentration to group 1, 3ng/ml to group 2 and 4ng/ml to group 3 and maintained a partial pressure of CO2 in the vein around 30 mmHg during the operation. After induction of anesthesia, injection of propofol, and the dura mater was opened, we measured mean arterial blood pressure, heart rate, respectively, measured partial pressure of CO2, hematocrit, oxygen saturation sampling the arterial blood, measured oxygen saturation sampling jugular bulb. RESULTS: There were no differences of mean arterial blood pressure, heart rate, hematocrit, arterial blood partial pressure of CO2, oxygen saturation, or jugular bulb oxygen saturation among the groups. In addition, there were no statistical differences of variables measured before and after injecting propofol and the dura was opened. For 1 in group 1, 2 in group 2, and 3 in group 3, jugular oxygen saturation dropped below 50% after injecting propofol, but was not verified statistically. CONCLUSIONS: There were no significant hemodynamic effects when we used propofol with the volatile anesthetic in neuroanesthetic management.

The Clinical Usefulness of Translabyrinthine Approach for Removal of the Vestibular Schwannomas

OBJECTIVE: To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. MATERIALS AND METHOD: To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection. RESULTS: The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit. CONCLUSION: Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.

Diagnostic Value of the Change of Signal Intensity at the Jugular Bulb in Sigmoid Sinus Thrombosis / 实用放射学杂志

Objective To study the value of the changes of signal intensity at the jugular bulb in diagnosing sigmoid sinus thrombosis.Methods MR imaging examinations were performed in 27 cases with cerebral venous sinus thrombosis(transverse and sigmoid sinuses).The signal intensity at the jugular bulb was evaluated in comparison with that in 20 healthy persons,and the results were dealed with Wilcoxon rank sum test statistically.Results In sigmoid sinus thrombosis,the signal intensity at ipsilateral jugular bulb was higher than that in healthy group(P