The Medial wall of the Jugular Foramen

Abstract

OBJECTIVE: To better understand the variable and complex anatomy of the jugular foramen (JF) and the relationship between the neurovascular structures in the medial wall of the jugular bulb (JB). STUDY DESIGN: A temporal bone anatomic study. SETTING: A temporal bone laboratory within a hearing research facility. SUBJECTS AND METHODS: Twenty-two temporal bones were dissected under the operating microscope. The JF anatomy was exposed by using the modified infratemporal fossa approach (no rerouting of the facial nerve). Pictures were taken at various intervals during the dissection. Distances between important structures were measured with two-point calipers and transferred to a millimetric scale. RESULTS: The right JF was found to be larger than the left side in 72.7 percent of the dissected temporal bones. A fibrous septum separated the glossopharyngeal (CN IX) from the vagus (CN X) and accessory (CN XI) nerves in 19 specimens (86.4%), and a complete bony septum was present in three specimens (13.6%). The CNs IX, X, and XI traveled anteromedially to the JB within the JF. The inferior petrosal sinus (IPS) drained into the medial wall of the JB at various locations by two or more channels. In most of the specimens (86.4%), the IPS separated CNs IX and X. CONCLUSION: The lower cranial nerves have an intimate relationship to the medial wall of the JB. Within the JF, the neurovascular structures vary in size, shape, and location. To minimize surgical morbidity, the surgeon should be familiar with the complex anatomy of the JB and its variations.