Neurogenic tumors located in the posterior mediastinum, generally require surgery which be confronted with greater risk,therefore, to design the best surgical approach and surgical methods is essential. A 67-year-old female patient had pharyngeal foreign body sensation and dysphagia. Thyroid ultrasound showed the right thyroid had a little nodule, and the left thyroid had a hypoechoic lumps. Neck enhanced CT showd mediastinal mass, esophageal tumor origin or stromal tumor? We used the jugular approach to resect the tumor which eventually diagnosed as schwannoma. The meditational benign tumor with an envelope easy to peel can employ the jugular approach to resect it completely.
Aged ; Female ; Humans ; Jugular Veins ; Mediastinal Neoplasms ; surgery ; Mediastinum ; pathology ; Neck ; surgery ; Neurilemmoma ; surgery

OBJECTIVETo describe a case of Ehlers-Danlos syndrome type IV and its pedigree in China.

METHODSClinical materials of a case of Ehlers-Danlos syndrome type IV and a pedigree of 6 members within 4 generations were analyzed. Dilated internal jugular vein in the proband was removed by operation. The diagnosis, surgical treatment, and postoperative complications were retrospectively reviewed.

RESULTSVessels of the proband in the pedigree were crisp and easily lacinated during the procedure of removing his internal jugular vein. Repeating postoperative hematomas were found though complete stanching was achieved during the operation. The patient was successfully recovered by promptly debridgement and needle sucking. The other 5 members of the pedigree all had the triads of Ehlers-Danlos syndrome.

CONCLUSIONSThough it was of extremely low morbidity rate, the high mortality rate and complication of Ehlers-Danlos syndrome deserve great attention during surgical management, especially in patients with Ehlers-Danlos syndrome type IV. Surgeons should be aware of the ponderance of its complications and combined diseases to avoid fatal intraoperative vascular lascination and incontrollable hemorrhage.

China ; Ehlers-Danlos Syndrome ; genetics ; surgery ; Humans ; Jugular Veins ; surgery ; Male ; Middle Aged ; Pedigree

OBJECTIVE: To discuss the diagnosis and management of pulsatile tinnitus of venous origin. METHOD: A retrospective study was conducted on 12 patients who were diagnosed with pulsatile tinnitus of venous origin and treated with ligation of internal jugular veins. We reevaluated the evidences of identifying pulsatile tinnitus of venous origin and reviewed the short-term and long-term postoperative effects and complications. We also reviewed associated articles in this report. RESULT: Seven patients got relief of tinnitus in less than one week after the surgery, while the other 5 patients had no relief. Seven patients were inquired in this study and the other five lost to follow-up. According to the long review (from one to five years postoperatively), two patients who acquired immediate effect got relief of tinnitus, four including complained of no relief and the seventh aggravated into roaring. Three patients who got no immediate relief got no improvement at all. No one in our review complained of any complications. CONCLUSION It's assumed that a history of pulsatile tinnitus, alleviation of tinnitus when pressing jugular veins, tinnitus changing with head position or posture and no occupying lesion in temporal CT scan or cranial MRI are inadequate in diagnosing pulsatile tinnitus of venous origin. Vascular imaging is also necessary to exclude other pathological changes like dura arteriovenous fistula, sigmoid diverticulum and so on. CT arteriography and venography are recommended preferentially. Ligation of internal jugular veins is controversial in patients who have no absence of transverse and sigmoid sinus and identified as pulsatile tinnitus of venous origin.
Adult ; Female ; Humans ; Jugular Veins ; surgery ; Middle Aged ; Retrospective Studies ; Tinnitus ; diagnosis ; surgery ; Vascular Surgical Procedures

OBJECTIVE: To summarize the surgical experience of totally implantable venous access port in children with malignant tumors, and to explore the coping methods of surgical complications. METHODS: The clinical data of 165 children with malignant tumors implanted in totally implantable venous access port in Department of Pediatric Surgery, Peking University First Hospital from January 2017 to December 2019 were retrospectively analyzed. The operation process, complications and treatment of complications were observed and counted. RESULTS: The children in this group were divided into external ju-gular vein incision group (n=27) and internal jugular vein puncture group (n=138) according to different surgical methods, and the latter was divided into ultrasound guided puncture group (n=95) and blind puncture group (n=43). No puncture complications occurred in the external jugular vein incision group, and the average time for successful catheterization and the number of times for catheter to enter the superior vena cava were more than those in the internal jugular vein puncture group [(9.26±1.85) min vs. (5.76±1.56) min, (1.93±0.87) times vs. 1 time], with statistical significance. The average time of successful catheterization, the success rate of one puncture, the average number of punctures and the incidence of puncture complications in the ultrasound guided right internal jugular vein puncture group were better than those in the blind puncture group [(5.36±1.12) min vs. (6.67±1.99) min, 93.68% (89/95) vs. 74.42% (32/43), (1.06±0.24) times vs. (1.29±0.55) times, 2.11% (2/95) vs. 11.63% (5/43)], with statistically significant differences. The total incidence of complications in this study was 12.12% (20/165). Pneumothorax occurred in 1 case, artery puncture by mistake in 1 case, local hematoma in 5 cases, venous access port related infection in 4 cases (venous access port local infection in 2 cases, catheter related blood flow infection in 2 cases), subcutaneous tissue thinning on the surface of port seat in 2 cases, port seat overturning in 1 case, poor transfusion in 4 cases (catheter discount in 1 case, catheter blockage in 3 cases), and foreign bodies gathered around the subcutaneous pipeline in 2 cases. There were no complications, such as catheter rupture, detachment and catheter clamping syndrome. CONCLUSION Totally implantable venous access port can provide safe and effective infusion channels for children with malignant tumors. Right external jugular vein incision and ultrasound-guided right internal jugular vein puncture are reliable surgical methods for children's totally implantable venous access port implantation. Surgeons should fully understand the complications of the venous access port, take measures to reduce the occurrence of complications, and properly handle the complications that have occurred.
Humans ; Child ; Catheterization, Central Venous/methods* ; Retrospective Studies ; Vena Cava, Superior ; Jugular Veins/surgery* ; Neoplasms/surgery*

Adolescent ; Catheterization, Central Venous ; adverse effects ; Humans ; Jugular Veins ; Male ; Mammary Arteries ; injuries ; Subclavian Artery ; surgery

OBJECTIVE: To explore the possibility of far-lateral retro-condylar approach in an attempt to apply endoscope. METHOD: For anatomical information, the microneurosurgical anatomical dissection, observation and measurement had been performed under microscope and endoscope by mimicking the far-lateral retro-condylar approach on 10 adult cadaver heads and 10 adult dry skulls. RESULT: The complex relationship exists between the osseous jugular foramen and its adjacent structures. The exposed anatomic structures of jugular foramen region were observed under microscope and endoscope without drilling occipital condyle and jugular tubercle. CONCLUSION With the technology of modern microsurgery and endoscope, several diseases in jugular foramen region can be operated via far-lateral retro-condylar approach without drilling occipital condyle and jugular tubercle.
Adult ; Endoscopy ; Female ; Humans ; Jugular Veins ; anatomy & histology ; Male ; Occipital Bone ; anatomy & histology ; surgery

BACKGROUND: This study evaluated the position and relationship between the right internal jugular vein (IJV) and the surrounding external landmarks using ultrasonography. METHODS: Fifty-four patients undergoing central vein access for cardiac surgery were enrolled in this study. The IJV, carotid artery (CA) and sternocleidomastoid muscle (SCM) at the cricoid cartilage level in 15o trendelenburg position with 30o head rotation were examined using a two dimensional ultrasound transducer of a TEE machine. Images of the vessels and the demographic data of the patients were recorded and analysed. RESULTS: At the level of the cricoid cartilage, the position of the right IJV was medial to middle of the clavicular head of the SCM muscle in 26 cases (48.2%), lateral in 11 cases (20.4%) and just above the middle of clavicular head of the SCM muscle in 17 cases (31.5%). In 43 patients (79.6%), the IJV overlapped the CA anterolaterlly < 5 mm, and these cases were regarded as normal. Ten patients (18.5%) had a medially positioned IJV overlapping the CA more than 5 mm and the IJV was positioned lateral to CA in 1 (2%) patient. The mean ratio of the overlapped diameter and the diameter of the CA was 33.6% and the overlapping ratios were greater than 50% in 10 patients (31.4%). The mean skin-to-vein distance at the angle of 30degrees was 1.82 cm. CONCLUSIONS: In 18.5% of patients positioned in the 15o Trendelenburg position, with their head turned to the left 30degrees, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique.
Carotid Arteries* ; Catheterization ; Cricoid Cartilage ; Head* ; Head-Down Tilt* ; Humans ; Jugular Veins* ; Prospective Studies* ; Punctures ; Thoracic Surgery ; Transducers ; Ultrasonography ; Veins

BACKGROUND: Internal jugular vein access is an essential part of patient management in many clinical settings and is usually achieved with a blind, anatomical landmark-guided technique. The purpose of this study is to evaluate whether a 2-dimensional ultrasound technique can improve on the traditional method. METHODS: Eighty patients undergoing elective open heart surgery were randomly assigned to an anatomical landmark group or ultrasound group (each n = 40). With the patient in the supine position, the head was rotated 30o to the contralateral side and triangle formed by the clavicle and both heads of the sternocleidomastoid muscle were identified. We accessed the internal jugular vein from the apex of the triangle toward the ipsilateral nipple in the anatomical landmark group. The internal jugular vein and carotid artery were visualized with two-dimensional ultrasound. We compared the number of advances made with the central venous cannulation needle, the time to blood aspiration, complications and failure rate. RESULTS: The failure rate was 22.5% using the anatomical landmark technique and 5% using the ultrasound technique. The vein was entered on the first attempt in 60% of patients using the landmark technique and in 63% using ultrasound (P>0.05). Mean attempts for puncture were 1.9 (anatomical) vs 1.6 (ultrasound-guided) (P>0.05). Complications occurred in 20% of cases using anatomical landmarks and in 5% using ultrasound (P>0.05). The average access time was 26.5 seconds by the anatomical approach and 56 seconds by the ultrasound approach (P< 0.05). CONCLUSIONS: Ultrasound-guided cannulation of the internal jugular vein did not significantly decrease failure rate, access time, complications, and attempts for puncture, nor did it increase the amount of successful first attempts. However an investigation using a larger number of patients will be needed.
Carotid Arteries ; Catheterization* ; Clavicle ; Head ; Humans ; Jugular Veins* ; Needles ; Nipples ; Punctures ; Supine Position ; Thoracic Surgery ; Ultrasonography ; Veins

In case of cardiopulmonary bypass, organ transplantation and massive transfusion, the electrolyte(Na+, K+, Ca++) and pH are very changeable, and it is very important to correct the pH and electrolyte immediately. We studied the bedside electrolyte monitoring with VIA(Vascular Intermittent Access) 1-01 and its accuracy validation. We selected 13 patients who went an open heart surgery in the Seoul National University HospitaL The patient was catheterized with 16 G triple lumen catheter into the SVC-right atrium junction via right internal jugular vein. Then we connected VIA 1-01 to one lumen. The electrolyte samplings were done during perianesthetic period. The electrolyte values(Na+, K+, ionized Ca++) of each sample was measured by laboratory, NOVA of PAR(postanesthetic recovery room) and VIA 1-01. We compared the values with correlation. The Pearson product-moment coefficient(r) of laboratory vs VIA 1-01 are 0.9073(Na+), 0.9471(K+) 0.6485(Ca++). The r of NOVA vs VIA 1-01 are 0.6348(Na+), 0.9330 (K+), 0.5206(Ca++ ). The r of laboratory vs NOVA are 0.6719(Na+), 0.9532(K+ ), 0.8221(Ca+). All pvalues of r were lower than 0.01. We conclude that bedside electrolyte monitoring with VIA l- 01 is very useful to critically ill-patient and major operations during anesthesia and it improves the prognosis of such patients.
Anesthesia ; Cardiopulmonary Bypass ; Catheters ; Humans ; Hydrogen-Ion Concentration ; Jugular Veins ; Organ Transplantation ; Prognosis ; Seoul ; Thoracic Surgery ; Transplants

OBJECTIVETo discuss the method of microsurgical treatment for jugular foramen tumor (JFT).

METHODSTen patients with dumbbell-shaped JFTs who were microsurgically treated by the same group were retrospectively studied, the surgical approaches includes infratemporal approach and modified far lateral approach according to tumors' size, blood feeding, hearing and growth manner. Cranial nerve function, pre- and postoperative complications, follow-up data were presented and discussed.

RESULTSGross total tumor removal was achieved in 7 patients, subtotal removal in 2 cases, partial removal in 1 case, postoperative cerebrospinal fluid leaking in 1 cases, postoperative new cranial nerve defects in 1 cases, aggravation in 2 cases. Postoperative deficits of the cranial nerves improved in 80 percent of the patients. Favorable facial function in 6 months postoperatively (House-Brackmann grade system in Grade 1 and Grade 2) was noted in 7 of the 10 patients. The postoperative level of hearing was preserved in 3 of the 6 patients with residual hearing. Recurrence was noted in 1 case during the follow-up period.

CONCLUSIONSSurgical total removal of JFT is possible depends on microsurgical operation with the two approaches with lowly additional neurological deficits. The function of preoperative affected cranial nerves can be recovered.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Jugular Veins ; Male ; Microsurgery ; methods ; Middle Aged