Research Paper Volume : 2 | Issue : 12 | December 2013 • ISSN No 2277 - 8179

MORPHOLOGICAL VARIATION IN THE Medical Science

STRUCTURE OF THE JUGULAR FORAMEN KEYWORDS : Jugular Foramen (JF),
Anteroposterior Diameter (APD), Trans-
IN ADULT HUMAN DRIED SKULL verse Diameter (TVD), Septation, Dome
IN NORTH INDIA
Rahul Rai Department of Anatomy, Career institute of medical sciences and hospital, Sitapur
hardoi bypass road, Lucknow-226020
Shailaza Shrestha Department of Biochemistry, Goldfield institute of medical sciences and research,
Chhainsa, Ballabhgarh, Faridabad

ABSTRACT Jugular foramen being difficult to approach surgically, a detailed morphological and anatomical knowledge
of it is required. 100 dried adult human skulls were examined. The foramen was larger on right side in 74%,
on left side in19% and equal in both sides in 7% cases. 68% skulls had complete septation on right and 21% on left side whereas
32% contained partial sepatation on right and 79% on left side respectively. Dome was found bilaterally, on right side only, on left
side only and absent on both sides in 48%, 30%, 10% and 12% of the cases respectively. The mean±standard deviation of APD on
the right and left sides were 6.92±1.53mm and 8.1±1.49 mm while the TVD measured 12.9±3.37 mm and 13.0±3.53 on the right and
left respectively. APD was significantly greater on right side (p<0.0001) and showed significant positive correlation with that of left.
Similar was the case with TVD.

Introduction of all primary intracranial tumours [10].

The JF is a large irregular hiatus that lies at the posterior end
of the petro occipital suture between the jugular process of the Surgical resection is the treatment of choice in the majority of
occipital bone posteromedially and the jugular fossa of the pe- these cases. As neurosurgeons become bolder in approaching
trous part of the temporal bone anterolaterally [1]. It courses this region, the need for familiarity with the detailed anatomy of
anteriorly, then laterally and finally inferiorly through the skull this region becomes greater. The present study was embarked
base. Anteriorly it is separated from the inferior carotid open- on to examine the anatomy of the jugular foramen including its
ing by a bony ridge called the carotico jugular spine. The JF is dimensions, and to discover the degree of predominance, if any,
lateral to the hypoglossal canal and the two are separated by an of this opening in adult human skulls in north india.
osseous bar [2].
Material and methods
According to Gray’s Anatomy, the lower posterior border of A total of 200 jugular foramina were examined from 100 adult
the foramen is smooth with the upper border being sharp and dry skulls. The skulls were obtained from the Department of
notched. Sometimes the margins of the notch extend to divide Anatomy, Teerthanker Mahaveer Medical College and Research
the foramen into 2 or 3 compartments. The anterior part is Center, Moradabad, India. The length and width of the jugular
the petro-occipital fissure which extends forward to foramen foramina were determined. Metric measurements (sagittal and
lacerum. The remainder of the jugular foramen is jugular fossa transverse diameters) were taken using Vernier calliper. The
which is divided into two parts by a bony projection called the foramina were also studied for the presence of complete or par-
jugular tubercle [3]. tial septation, presence of dome and size predominance. Data
analysis was done with SPSS version 16. A comparison of the
Three compartments of JF include :- Anterior compartment, dimensions was made using Student’s t-test. The association
a smaller venous compartment (petrosal part) containing the between continuous variables was investigated by Pearson’s
inferior petrosal sinus; Middle compartment ,a neural compart- correlation coefficient.
ment containing the CN IX to CN XI; Posterior compartment, a
larger venous compartment (sigmoid part) containing the sig- Results
moid sinus, jugular sinus meningeal branch of occipital & as- The mean length of jugular foramen on the right and left were
cending pharyngeal arteries [4,5]. Within the jugular foramen 23.62mm and 22.86mm, while their widths measured 7.83mm
the glossopharyngeal nerve gives off the glomus bearing tym- and 6.83mm respectively (Table - 1). Predominance of one of
panic branch called the nerve of Jacobsn and the vagus nerve the two foramina appeared in 93% of cases. Predominance on
gives auricular branch called Arnold’s nerve. the right (R) was 74% and 19% on the left (L). 7% cases showed
equal on both sides (Table 2). Complete septation was present
The sigmoid and petrosal parts are separated by:- (a) A bony on 68% cases on the right side and on 21% of cases on the left
processe called as the inter jugular processe, which originates side whereas 32% had partial septation on the right side and
from the opposing surfaces of the temporal and occipital bones, 79% on the left side. Dome was present bilaterally, on right side,
(b) A dural septum which connects these two bony structures. on left side and absent on 48%, 30%, 10%, 12% of the cases
More often there is no septation and the JF exists as one com- respectively.
partment [6].
There was statistically significance between the foramens of
JF is difficult to conceptualize and assess surgically because it two sides in terms of width but no significant difference in case
varies:- (a) In size and shape in different crania, (b) from side to of length (Table 2 and 3). The APD of jugular foramen on right
side in the same cranium, (c) from its intracranial to extracrani- side showed significant positive correlation with that on the
al end in the same foramen and also because of: (d) Its complex left side. Similar was the case with TVD on right and left side (
irregular shape and its curved course, (e) Its formation by two p<0.05, table 3).
bones and (f) The numerous nerves and venous channels that
pass through it [2,7]. Table 1. (Minimum & maximum values with µ ± sd )

Variety of lesion may occur in the JF, arising from the structures Min Max Mean ±SD
normally found within the JF or from contiguous structures [8]. Diameter (mm) (mm) (µ±sd)
The most common tumours or lesions include glomus jugulare
tumours, neuroma, meningomas, metastatic carcinoma, chron-
APDR 4.5 10.7 6.92 ± 1.53
droma, nasopharynx carcinoma & carcinoma of tympanic cavity
[9]. Schwannoma (neuroma) represents approximately 7–10%

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 Volume : 2 | Issue : 12 | December 2013 • ISSN No 2277 - 8179
Research Paper

Min Max Mean ±SD occipito-temporal suture. The temporal side of the foramen is
Diameter (mm) (mm) (µ±sd) the jugular fossa (bulb), bounded superiorly by the bony floor
of the middle ear. The glomus jugulare lies in the fossa or middle
ear near the fossa and the glomus tumor arises in this area [11].
APDL 4.2 10.5 8.1 ± 1.49
In this study, 100 skulls were analysed for their size, length,
width, presence of dome and septation. Predominance of JF was
TVDR 5.3 19.8 12.9 ± 3.37 on the right side (74%) with maximum cases of complete septa-
tion (68%). Most of the skulls showed to have dome bilaterally
(48%).
TVDL 5.1 19.9 13.0 ± 3.53
R. R. Sturrock found that in 69% of cases the right JF was larger
SD→standard deviation than the left and in 23% the left JF was larger, with the remain-
der being of equal size. A dome caused by a superior jugular
Table 2. Comparison of APD of Right and Left side bulb was present bilaterally in 54%, on the right only in 30%,
on the left only in 6% and was absent bilaterally in 10% of the
Side Mean (µ) SD p cases. Incomplete septation was present on the right in 1.3%
and on the left in 10.9% of cases. A complete division was found
APDR 8.096 mm 1.478 <0.0001* in 3.2% of cases for both the right and left sides [12].

APDL 6.917 mm 1.519 In a study of M. Tahir. Hatiboglu etal 61.6% cases had larger
foramen the right side and 26% on the left side with the remain-
*→statistically significant (p<0.05) der being of almost equal size in both the sides. Dome was pre-
sent bilaterally in 49%, on the right only in 36%, on the left only
Table 3. Comparison of TVD of Right and Left side in 4.6%, it was absent bilaterally in 10.3%. Complete bony sep-
tation occurred in 5.6% on the right and in 4.3% on the left, par-
Side Mean (µ) SD p tial septation was observed in 2.6% on the right and in 19.6%
TVDR 12.921 mm 3.257 0.9661 on the left. Another foramen which was completely separated
by a spicule of bone and which transmits the inferior petrosal
TVDL 13.01 mm 3.508 sinus was present in 5.6% of skulls on the right and in 4.6% on
the left [13]. Patel MM etal observed the presence of gutter on
Table 4. Pearson correlation coefficient (r) and p value the lateral side of jugular foramen. This study postulates the hy-
pothesis that the presence of size of gutter is inversely propor-
APD TVD tional with the size of dome and helps in accommodating the
SN variable right APD left right TVD left superior jugular bulb of internal jugular vein [14].

APD r 0.228 0.102 -0.014 The size and shape of the jugular foramen is related to the size
1 right - of the internal jugular vein and the presence or absence of a
p 0.022* 0.313 0.917
prominent superior bulb. The right foramen is usually larger
r 0.228 -0.006 0.042 than the left. There is a very wide variation in the anatomy of
2 APD left - the intra cranial venous sinuses which accounts for variation in
p 0.022* 0.98 0.967 size and shape of jugular foramen. The difference in size of the
r 0.102 -0.006 0.589 two internal jugular veins is already visible in the human em-
3 TVD - bryo at the 23mm stage and probably results from differences in
right p 0.313 0.98 0.001* the pattern of development of the right and left brachiocephalic
r -0.014 0.042 0.589 veins [2]. The larger superior sagittal sinus continues in suc-
4 TVD left - cession as right transverse sinus, right sigmoid sinus and right
p 0.917 0.967 0.001* internal jugular vein whereas the smaller inferior sagittal sinus
continues in succession as straight sinus, left transverse sinus,
*→statistically significant (p<0.05) left sigmoid sinus and into left internal jugular vein [15].

Table 5. Presence of dome in jugular The bony growth reduces the size of JF and jugular fossa. It
might cause the neurovascular symptoms which can mimic the
Dome Bilateral Right Left Absent symptoms caused by jugular meningiomas, glomus jugulare tu-
Percentage 48% 30% 10% 12% mors of choleastatoma. The bony growth in the jugular fossa re-
gion might compress the superior bulb of internal jugular vein
Table 6. Size of the jugular foramen which in turn might result in venous congestion in the cranial
cavity. The compression of 9th 10th and 11thnerves might re-
Size percentage sult in paralysis of pharynx, larynx and palate [16].
Right>Left 74%
Conclusion
Left>Right 19% The surgical anatomy of the JF and its contents is complex.
Therefore, an excellent knowledge of its variations and the rela-
Right=Left 7% tionships between its neurovascular structures is critical when
surgically approaching this complex area, in order to maximize
Table 7. Septation of jugular foramen the surgical outcome and decrease postoperative complications
when treating the pathology of this region.
Side Complete (%) Partial (%)
Right 68% 32%
Left 21% 79%

Discussion
The JF is one of the most complicated anatomic structures of the
skull base. It is bounded by the temporal and occipital bones. It
is an aperture between the medial and lateral portions of the

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